A. Statewide Overview of Substance Use

Substance use by parents in DFPS cases is very common. In 2019, 66% of children removed from their homes and placed in out-of-home care had parental alcohol or other drug abuse as an identified condition for removal.[123]

Special Issue: The term “abuse” is highly associated with negative judgments and punishments. The preferred terms are substance “use” when referencing illicit drugs and “misuse” for prescription medications used other than prescribed. [124]

Methamphetamine continues to be perceived as the primary drug threat by the three Drug Enforcement Agency (DEA) Field Divisions covering Texas. Cocaine indicators continue to decrease. However, heroin and fentanyl indicators have been increasing, as fentanyl is specifically used to “cut” heroin. The number of seizures of fentanyl items identified by law enforcement has risen from 23 in 2006 to 841 in 2020.[125]

Death rates associated with heroin have increased steadily since 1999 with the highest number of deaths occurring in the 24-34 age group. There has been a decrease in heroin-related poison center calls, even while a rising number of toxicology reports, deaths, and seizures are being identified; however, Texas has not suffered the epidemic of overdoses seen in the northeast United States.[126]

1. Useful Definitions from the Health and Human Services Commission (HHSC)

•   Substance Use: use of a substance.

•   Substance Misuse: using a substance in a way that is not consistent with medical or legal guidelines (e.g., using two pills rather than one as prescribed to assist with sleep).

•   Harmful Use: refers to using legal and illegal substances, such as alcohol or prescription medications, in excess or in ways they are not intended may cause harm. Examples of harmful use are binge drinking or taking medication in a way that is not prescribed, such as taking too much medication.

•   Substance Use Disorder (SUD): a condition marked by a cluster of cognitive, behavioral, and physiological symptoms in which the use of a substance leads to clinically significant impairment or distress in a person's life. Substance use disorders range can range widely in severity (mild, moderate, or severe), with severe substance use disorders typically including clinical criteria of tolerance and withdrawal.

•   Recovery: a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. The process of recovery is highly personal and occurs via many pathways. It may include clinical treatment, medications, faith-based approaches, peer support, family support, self-care, and other approaches. Recovery is characterized by continual growth and improvement in one's health and wellness and managing setbacks. Because setbacks are a natural part of substance use, resilience becomes a key component of recovery.[127]