The personal and family tragedies related to addiction are heartrending and, quite often, desperate. The struggles to break addiction and restore lives are uniquely challenging. And the scientific breakthroughs now taking place to help understand, prevent, and successfully treat addiction are nothing short of astonishing. This is how the National Institutes of Health report the current state of our country when it comes to addictions, mental health conditions, and progress being made to solve this great dilemma.
But the question remains concerning the cost of treatment vs. the cost of simply allowing addictions to continue – for individuals as well as for our country.
What Are the Statistics on Addiction Today?
With nearly one in 10 Americans over the age of 12 classified with substance abuse or dependence, addiction takes an emotional, psychological and social toll on the country. The economic costs of substance abuse and addiction alone are estimated to exceed a half trillion dollars annually in the U.S. due to health care expenditures, lost productivity and crime. Now that’s a pretty big tab to pick up while all addiction gives you in return is pain, heartache, a consuming obsession for more alcohol or drugs, and a potentially productive life wasted.
In raw numbers, addiction affects 23.2 million Americans — of whom only about 10 percent are receiving the care they need. While treatment is being shown to yield positive results, many families are unwilling to look outside the home for help due to concerns about both cost and, perhaps even more powerfully, the stigma associated with admitting there’s a problem in the family.1
Drug abuse is a major public health problem that impacts society on multiple levels – recognized by approximately 82% of Americans as a “Very Serious Problem” (actually, considered the greatest problem out of the 36 top health issues facing us today).
Directly or indirectly, every community is affected by drug abuse and addiction, as is every family. Drugs take a tremendous toll on our society at many levels.2
Taking a Closer Look at the Costs Involved
To put our nation’s $500+ billion alcohol and drug addictions price tag in perspective, here’s the estimated cost to our country for two other highly prevalent health issues:
- Diabetes costs $131.7 billion annually
- Cancer costs $171.6 billion annually
Furthermore, one-third of AIDS cases reported in 2000 (11,635) and most cases of hepatitis C (about 25,000 in 2001) in the U.S. are associated with drug use injections. In addition, approximately half of pediatric AIDS cases (4,700 reported through 2002) result from injection drug use or sex with injection drug users by the child’s mother.
Many of America’s top social problems also relate to drug abuse:
- Drugged Driving – The National Highway Traffic Safety Administration estimates that drugs are used by approximately 10 to 22 percent of drivers involved in crashes, often in combination with alcohol.
- Violence – At least half of the individuals arrested for major crimes including homicide, theft, and assault were under the influence of illicit drugs around the time of their arrest.
- Child Abuse – At least two-thirds of patients in drug abuse treatment centers say they were physically or sexually abused as children. And approximately 50% to 80% of all child abuse and neglect cases substantiated by child protective services involve some degree of substance abuse by the supervising parents.
- Crime – As many as 60% of adults in federal prisons are there for drug-related crimes.
- Health and Education Services – Children with prenatal cocaine exposure are much more likely to need special education services in school – an estimated additional cost of $23 million/year.
- Workplace – According to numbers gleaned from 1997, illicit drug users were more likely to have missed at least two days of work in the past month and to have switched between three or more employers in the past year. A California study found that 70% of the estimated costs associated with alcohol abuse can be attributed to lost productivity (www.drugwarfacts.com).
Drug abuse impacts the individual, the family, the community and the entire country – basically everybody knows someone who is affected by the ravaging effects of alcohol and drugs.
At a more personal level, here are some startling statistics concerning substance abuse:
- Morbidities – Each year, approximately 40 million debilitating illnesses or injuries occur among Americans as the result of their use of tobacco, alcohol and drugs.
- Mortalities – According to our calculations for 2000, approximately 460,000 deaths were attributable to illicit drug abuse and smoking.2
In today’s difficult economic climate, it is more important than ever to examine the value of substance abuse intervention and treatment, and to invest in cost-effective, evidence-based approaches that will cut costs and save lives.
“Research shows that every dollar spent on substance abuse treatment saves $4 in healthcare costs and $7 in law enforcement and other criminal justice costs.”
Treatment Benefit Dollars Outweighed by the Resulting Savings
Research shows that every dollar spent on substance abuse treatment saves $4 in healthcare costs and $7 in law enforcement and other criminal justice costs. On average, substance abuse treatment costs $1,583 per patient and is associated with a cost offset of $11,487 – that exceeds a 7:1 ratio of benefits to costs.
Washington is just one of many states that has figured out that providing adequate mental health and addiction treatment benefits can dramatically reduce healthcare costs and Medicaid spending. Case in point: Washington found that providing a full addiction treatment benefit resulted in per patient savings of $398 per month in Medicaid spending.
Medical costs for people in treatment were $311 lower per month than for those who needed but did not receive treatment, and state hospital expenses for those in treatment were lower in comparison by $48/month. For those who received treatment, the likelihood of being arrested decreased 16% and the chance of felony convictions dropped 34%.
Yes, the Washington State Institute for Public Policy has found that treatment conducted within the community is extremely beneficial in terms of cost, especially compared to prison costs. Every dollar spent on drug treatment in the community is estimated to return $18.52 in benefits to society.3
Overall Spending on Addiction Treatment: Not in Line with the Severity of the Problem
While it has already been stated that drug abuse is considered our nation’s number one health concern by the general public, only about $21 billion (data from 2003) was spent on drug and alcohol addiction treatment. Representing 1.3 percent of all health care spending for that year, this statistic indicates how relatively little we are investing into the elimination of this catastrophic problem.3
Traditional Treatment Models that Have Proven to Be Most Effective
Determining treatment effectiveness is a complex endeavor that hinges on the interplay among many client, program and environmental factors. After more than 25 years of evaluations of various types of treatment programs, there are surprisingly few national longitudinal or multisite studies that offer universal, definitive “truths.” However, four studies represent broad and rigorous analysis of the effectiveness of drug treatment. These studies are the Drug Abuse Reporting Program (DARP), the Treatment Outcome Prospective Study (TOPS), the Drug Abuse Treatment Outcome Study (DATOS) and the California Drug and Alcohol Treatment Assessment (CALDATA). Collectively, these studies point to these four treatment modalities as the most effective:
- Therapeutic Communities – TCs are intensive, long-term, self-help, highly structured residential treatment modalities for chronic, hardcore drug users who have failed at other forms of drug abuse treatment. The following is known about TC treatment:
- Length of stay in treatment is predictive of outcome;
- Treatment is effective, although relapse and dropouts happen
- Pharmacological Treatment – With well-documented success, there are several factors that govern the effectiveness of these programs:
- The intake population (i.e., substantial selection occurs during the screening process);
- The length of time an individual waits for treatment;
- The dropout frequency of those on the waiting list;
- The point at which the individual is in the treatment process;
- The client’s environment;
- The points at which success is monitored;
- The services integrated into the overall service package; and
- The treatment process, including dosages, pattern and duration of treatment, training of providers, funding, and program demand constraints.
- Outpatient Drug-free Treatment – These modalities include a range of protocols, from highly professional psychotherapy to informal peer discussions. While abstinence is the ideal goal of outpatient drug-free treatment programs, reduced drug use is commonly viewed as a more realistic objective and also is considered a sign of treatment efficacy. The clinical measures of effectiveness are particularly difficult to discern due to the enormous diversity within the modality and the relative scarcity of outcome studies.
- Inpatient Treatment – The treatment of drug dependence in a hospital, including medical supervision of detoxification, which have traditionally lasted for 28 days – though this duration has changed considerably since the emergence of managed care models in substance abuse services and currently may consist of as few as three days. The primary objective of inpatient drug-free treatment is to help the patient achieve and maintain a drug-free lifestyle. Additional objectives include the following: decreased involvement in illegal activities; increased productivity in work or school settings; improved social, family, and psychological functioning; and improved physical health. Improved psychological and family functioning facilitates improvement in other areas as well. Three well-known examples of inpatient treatment, each serving a different type of clientele, include: therapy-based programs, 12-Step programs, and multi-modality programs.4
As the Saying Goes… The Best Defense Is a Good Offense
Intervening early – before drug use or excessive alcohol use progresses to addiction – is among the most cost-effective ways to address substance abuse, reduce its costs to society, and improve public health. Too often, individuals with substance use problems believe that only severe cases of addiction require treatment; thus, many do not seek treatment until long after initiation, when their use has produced significant social, economic, health and/or legal consequences.
SBIRT is a good example of a proactive program actively in place… and seeing tremendous results. It is a comprehensive, integrated, public health approach for delivering early intervention and treatment services to people with, or at risk of developing, substance use disorders. Designed to take place in general medical settings that people routinely visit, this program identifies individuals with substance use problems before those problems progress too far.
SBIRT is a three-step process:
- Screening – This step involves quickly assessing the severity of the individual’s substance use in order to determine the appropriate level of treatment. Screenings take place in trauma centers, emergency rooms, community clinics, health centers and school clinics.
- Brief Intervention – This second step focuses on increasing the person’s awareness of substance use and encouraging changes in behavior.
- Referral to Treatment – This last step provides those who need more extensive substance abuse treatment with referral to specialty care.
Well-implemented SBIRT programs have demonstrated considerable success. For example: Washington’s program found significant healthcare cost reductions among 1,315 disabled Medicaid clients who received an intervention through the program. Administrators concluded that the potential reduction in Medicaid costs could be as high as $2.8 million per year for working-age disabled clients who receive a brief intervention.
Specific Medicaid cost reductions included: $185-195 per member each month after receiving a brief intervention; and $238-269 for each member per month in costs associated with inpatient hospitalization from emergency department admissions. In addition, the study found that costs were reduced due to fewer days of hospitalization stemming from emergency department visits. For the 1,315 patients who received at least one brief intervention through the program, there were approximately 1,300 fewer days of hospitalization per year.
The benefits of investing in early intervention and treatment for substance use disorders are indeed substantial. Addiction – like other chronic diseases – can be managed successfully with appropriate access to quality treatment. Early intervention tools can be implemented in existing systems, such as primary care settings and hospitals, to allow quick responses to substance use disorders and provide care for greater numbers of people. The overarching goal of treatment should be to help individuals achieve stable, long-term recovery and become productive members of society, and to eliminate the public health, public safety, and economic consequences associated with addiction.5
What Price Can Be Placed on a Restored Life?
What cost can be placed on a life, a person’s value to a family, and the fruits that can come through the reclaimed productivity of an individual – each one being so unique and significant to mankind?
Skywood offers a full-range of service options designed to reclaim and restore a damaged life. The particular type and extent of treatment depends entirely on the needs of each individual we serve.
“The Science of Addiction: Drugs, Brains, and Behavior”, NIH MedLinePlus, National Institutes of Health, https://www.nlm.nih.gov/medlineplus/magazine/issues/spring07/articles/spring07pg14-17.html , (Spring 2007).
“Magnitude”, National Institute on Drug Abuse, http://archives.drugabuse.gov/about/welcome/aboutdrugabuse/magnitude/ .
“Substance Use Treatment Data, Research, and Policies”, DrugWarFacts.org, http://www.drugwarfacts.org/cms/Treatment#sthash.zRSNFCaO.dpbs .
“Treatment Protocol Effectiveness Study”, Publications, Office of National Drug Control Policy, https://www.ncjrs.gov/ondcppubs/publications/treat/trmtprot.html , (March 1996).
“Cost Benefits of Investing Early in Substance Abuse Treatment”, Fact Sheet, Office of National Drug Control Policy, https://www.whitehouse.gov/sites/default/files/ondcp/Fact_Sheets/investing_in_treatment_5-23-12.pdf .