State of Addiction in Texas

Texas: Where Everything Is Bigger

Texas has many claims to fame – at 1.803 trillion (2018), its gross state product is the second highest in the United States and is higher than gross domestic products of Australia and South Korea. However, it also reportedly has one of the worst healthcare systems in America.³ In 2012, the federal Agency for Healthcare Research and Quality found that Texas ranked below the national average for the provision of care for breast cancer patients, in-home healthcare, treatment of cancer and diabetes, and care for the disabled and poor.^4,5 As far back as 2007, the Dallas Daily News attributed Texas’s healthcare problems to a combination of “politics, poverty and illegal immigration.” The border between Texas and Mexico is almost 2,000 miles, according to the Federation of American Scientists, giving it the second-highest number of illegal immigrants in a single state, after California; and the state’s poverty rate of 17.5% is above the national average.^6,7,8

However, one area of healthcare where Texas succeeds is in drug addiction treatment. In 2013, Trust for America’s Health published a report entitled Prescription Drug Abuse: Strategies to Stop the Epidemic, which found that the Lone Star State ranked the 8th lowest for drug overdose mortalities in the United States in 2010: 9.6 per 100,000 people died as a result of improper prescription drug abuse. By contrast, West Virginia was the state with the highest rate of prescription drug fatalities, with 28.9 deaths per 100,000 people.⁹

To be fair, Texas is still struggling. The figure of 9.6 per 100,000 is a 78% increase from 1999, when the state lost 5.4 people per 100,000 to drug overdoses. Nonetheless, Trust for America’s Health found that Texas scored a 6 out of 10 in implementing “promising strategies to help curb prescription drug abuse.”

The Centers for Disease Control and Prevention (CDC) consider the state of prescription drug abuse in the United States to be of “epidemic” proportions, saying that overdoses from the improper use of prescription drugs kills 44 people a day. The Director of the Johns Hopkins Center for Injury Research and Policy told Trust for America’s Health that more than 6 million people suffer from various physical or psychological disorders related to prescription drug abuse disorders, and the abuse of painkillers costs the United States almost .4 billion in terms of lost productivity, medical costs and legal fees.¹⁰

Rick Perry and the Model for Reform

Part of Texas’s success in combating drug abuse in the state is due to Rick Perry, the longest-serving governor in the history of the state (2000-2015). According to Globe News Wire, Texas had only seven drug courts when Perry took office; in 2014, when Perry was presented with the National Award for Criminal Justice Reform by the National Association of Drug Court Professionals, his state had 136 drug courts and 15 specialized courts for treating army veterans (focusing on the connection between combat-related stress disorders and substance abuse).^11,12

What’s changed? How is Texas transitioning from its lowly healthcare rank to becoming a “national and international model for reform,” where an estimated $2 billion are saved in closing prisons and giving Texas its lowest crime rates in years?

The Lesson from California

One of the solutions comes from one of Texas’s own problems that the Dallas Daily News mentioned: politics. The Daily Beast reports that from 1985-2005, Texas’s prison population jumped from 37,281 to 152,000, giving the state the second-highest incarceration rate across America. Prisons overflowed, forcing state officials to use county jails. Some convicts were forced to sleep on the floor; others were released early, some of them serving only a month for every year of their sentence before they were rotated out of the prison system to make room for a wave of new inmates.¹³

For as bad as Texas’s situation was, California had it much worse. The controversial “Three Strikes” law had the most populous state in the country seeing a 570% jump in its prison population from 1980-2010; in that same timeframe, the general population of California grew only 57%. The U.S. Supreme Court finally stepped in and decided that California’s state penitentiary system was in violation of the Eighth Amendment’s understanding of what constituted cruel and unusual punishment.^14,15,16

As California refocused its efforts away from going after nonviolent crime (as part of the equally contentious Proposition 47), Rick Perry took note. When the National Association of Drug Court Professionals bestowed upon him the National Award for Criminal Justice Reform, they noted his action in “[combining] accountability and extensive treatment.” Perry himself pointed out Texas’s focus on “specialty courts” that provide exclusive and distinct treatment services for patients from all walks of life, giving millions of Texans an alternative to being put into prison without any care or consideration given to social or mental health factors.

Texas’s Journey

As part of that drive, The Texas Tribune noted that lawmakers allocated unheard-of levels of funding to services to assist patients with mental health disorders. Spurred in part by a spate of mass shootings and the controversy over people with mental health problems having access to firearms, Texas lawmakers approved budget increases for mental health services that rank among the largest in the United States. The 2013 legislative session allocated around $300 million in that direction more than the previous session did. A mental health policy analyst for the Center for Public Policy Priorities said that the $2.6 billion earmarked by the Department of State Health Services is “unprecedented.”

It’s a drastic change from 2010, when Texas came 49th in the country in per capita expenditures for mental health services. Then, the state spent less than $1 for every $3 spent per patient in other states. Today, Texas is closer to the national average for mental health services expenditures.

A specific part of the drive goes towards reducing waitlists at community mental health services. July 2013 saw more than 5,200 adults and 190 children who were waiting to receive care at such facilities. The Texas State Legislature put aside around $48 million for community health centers to hire more psychiatrists, or do whatever they felt was necessary, so that the people who required mental health services the most could get them.

However, Texas’s Medicaid eligibility standards, which are among the most restrictive in the country, might disqualify a large number of people living below the poverty line, who have co-occurring mental health and substance abuse disorders, to receive the expanded health insurance covered offered by the Affordable Care Act. Low-income individuals, or those who are homeless or have criminal records, often have the greatest need for mental health and drug addiction services but the least access to them. The associate general counsel for the Texas Hospital Association tells The Texas Tribune that the people her organization sees the most with mental health issues are the ones who have no mental health coverage.¹⁷

Texas Culture and Substance Abuse

In 2010, the Houston Chronicle broke a story on the rise of prescription drug abuse in Texas, finding that 1,900 of the state’s residents died every year as a result of overdosing on their medications. In response, addiction expert Jane Maxwell led the calls for state legislators to fund a system to track prescription drugs in real time, and to create a system whereby state authorities could monitor overdose deaths to improve their responses.

Meanwhile, colleges took their own steps. Some schools have posted information about the causes and signs of overdoses on dormitory doors, offering classes and seminars on substance abuse. Some have even provided amnesty to students who are hesitant to ask for help, for fear that divulging drug use or illicit alcohol consumption might lead to punitive academic or legal measures.¹⁸

Such steps are especially notable because of the prevalence of dangerous substances on college campuses. Risky, impulsive behavior is widely considered to be “part of the college experience,” to the point where the National Institute on Alcohol Abuse and Alcoholism found that more than 80% of college students consume alcohol on campus.^19,20

In 2013, the University of Texas published a report on the substance abuse trends in Texas, disclosing that 58% of secondary school students (grades 7-12) in the state had used alcohol, making alcohol the “primary drug of abuse.” Twelve percent of secondary school students said that when they did consume alcohol, they would usually drink 5 or more beers in a row, behavior that fits the definition of binge drinking, which can lead to a heart attack, high blood pressure, poor judgment, and death.^21,22

An example of the deep penetration of drinking in Texas comes in an opinion piece written for the Dallas Morning News, where the writer quotes a statistic about Dallas County (population 2.37 million, making it the ninth most populous county in the United States): Almost 2,100 adults were arrested for providing alcohol to underage drinking. Other writers for the Dallas Morning News pointed the finger at adults who permit underage drinking parties on their property, which was blamed on “the degree to which drinking is so ingrained in [Texas] culture.” With beer being sold at the Six Flags Over Texas theme park, baseball games and ball games, the writer argues that Texas is indoctrinating its youngsters with the idea that the only way they can have fun is with a drink in their hand and another one on the way.²³

Texas and Marijuana

Marijuana possession, meanwhile, is one of the most common causes of arrest in Texas, with almost 70,000 adults arrested in 2013 for possession. They accounted for 60% of all drug possession-related arrests in the state. Despite Texas’s reputation for being deeply conservative (the state has elected Republican governors since 1994 and last voted for a Democrat in a presidential election in 1976), My San Antonio reports that 49% of Texans support legalizing small amounts of marijuana for recreational use, and 77% favor marijuana being legalized for medical use.²⁴

Perhaps anticipating the shift, then-Governor Perry spoke in favor of reducing penalties for small amounts of marijuana use. He spoke of how his policies of allocating resources away from prison sentences, and towards probation and progressive forms of treatment, have set a model for other states to follow. While still opposing the outright legalization adopted by Washington state and Colorado, Perry touted his “diversionary and rehabilitative programs” (such as drug courts) as examples of how decriminalization keeps minor offenders out of jail, keeps families together, and provides appropriate counseling and therapeutic services.²⁵