• Substance use: America’s number one health behavior problem

    In a year 2000 report, The National Center on Addiction and Substance Abuse (CASA) made the case that substance use/abuse was America’s number one health-related behavior problem [pdf].

    Substance abuse is public health problem number one in America today. [3] Sixty-one million Americans are hooked on cigarettes. Some 14 million are addicted to alcohol or abuse it. [4] Another 33 million binge drink at least once a month. Close to 14 million Americans use illegal drugs and about five to six million of them abuse or are addicted to drugs such as heroin, cocaine and amphetamines. [5] The age of first use of these substances has been declining. In their senior year of high school, 30.8 percent of teens binge drink, 23.1 percent regularly use marijuana, and 10.4 percent regularly use other illicit drugs. By the time teens graduate from high school, 55 percent have used an illicit drug. [6] Even the elderly do not escape this plague. An estimated 2.8 million women age 60 and older are hooked on psychoactive prescription drugs. [7]

    These rates of substance abuse tax every segment of our health care system, contributing to or causing more than 70 conditions that require hospitalization, complicating the treatment of most illnesses, prolonging hospital stays, increasing morbidity and sharply raising costs. [8] About a quarter of all deaths in the United States are caused, directly or indirectly, by substance abuse. [9] Substance abuse is a major contributor to the leading causes of death in the United States–heart disease, cancer and stroke. [10]

    This problem extracts an enormous toll from our health care dollar. Alcohol and drugs alone accounted for more than $34 billion in health care expenditures in 1995. [11] Tobacco easily adds another $30 billion to the tab. [12] Much of these costs–both human and financial–can be avoided through early detection, accurate diagnosis and effective treatment.

    There’s much more in the report. Since the report is 11 years old, I’d love to see an updated version of the above. I’m not suggesting the story has changed a lot (at least as CASA would tell it), but I really don’t know.

    Do you think CASA is on the mark here? Or is some other health behavior more costly or important in some way?

    I’ll blog more about substance use and its impact on health, as well as on this CASA report, soon.

    UPDATE: A follow-up is here.

    References

    3. Royce, J.E., & Stratchley, D. (1996). Alcoholism and other drug problems. New York: Free Press.

    4. National Institute on Alcohol Abuse and Alcoholism (NIAAA). (1996). Alcoholism: Getting the Facts. Rockville, MD.: National Institutes of Health, National Institute on Alcohol Abuse (NIAAA).

    5. Substance Abuse and Mental Health Service Administration, Office of Applied Studies. (1999). National household survey on drug abuse: Main findings 1998. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.

    6. Johnston, L. D., O’Malley, P. M., Bachman, J. G., & National Institute on Drug Abuse. (2000) The monitoring the future national results on adolescent drug use: Overview of key findings, 1999. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Drug Abuse.

    7. The National Center on Addiction and Substance Abuse (CASA) at Columbia University (1998). Under the rug: Substance abuse and the mature woman. New York, NY: The National Center on Addiction and Substance Abuse (CASA) at Columbia University.

    8. Califano, J. (1994). Radical Surgery. New York, NY: Times Books.

    9. McGinnis, J. M., Forge, W. H. (1993). Actual causes of death in the United States. JAMA, 270 (18), 2207-2212.

    10. Califano, J. (1994). Radical Surgery New York, NY: Times Books.

    11. Harwood, H., Fountain, D., Livermore, G., & The Lewin Group. (1998). The economic costs of alcohol and drug abuse in the United States, 1992. Washington, DC: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, National Institute on Alcohol Abuse and Alcoholism.

    12. CASA estimate based on: Harwood, H., Fountain, D., Livermore, G., & The Lewin Group. (1998). The economic costs of alcohol and drug abuse in the United States, 1992. Washington, DC: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, National Institute on Alcohol Abuse and Alcoholism: Center on Addiction and Substance Abuse (CASA) at Columbia University. (1995). Substance abuse and federal entitlement programs. New York, NY: Center on Addiction and Substance Abuse (CASA) at Columbia University.

     

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    • I would have thought diet, obesity and exercise issues would be more important. An organization devoted to a problem is not the most objective judge of the importance of that problem.

      I’m not suggesting substance abuse isn’t an important problem. It should be addressed.

      • I agree about the source, which is why I asked the question. However, the source cites other sources, so the appropriate critique would be one that delved into those and noted how the estimates are incorrect in some fashion.

        I do wonder about food-related behaviors vs substance use behaviors. Which is a bigger issue in terms of health and other costs to society? I confess, I do not know.

        • I don’t know either which is a bigger issue. Browsing the linked study didn’t reveal anything to settle the question. I didn’t look at any of the studies it cited.

          We should be addressing both problems. Figuring out a good way to address them would be nice. Is there anyone who doesn’t know that serious drugs, alcohol, bad diet and lack of exercise are bad? Denying healthcare to those who engage in unhealthy behavior is not likely to work.

          Would you know of any studies on the results of providing incentives to behave better?

          • Haven’t looked into it.

            There’s a big difference between “everybody knows XYZ” and the revealed knowledge/preferences of society in the way we behave, fund, talk about (or not), criminalize, and the like. Perhaps everyone knows they’d be healthier if they exercised, stopped smoking, cut down on alcohol and other drugs, and ate less processed crap loaded with sugar, fat, and salt, but then you look at our actually policies and culture and, guess what, in many ways we don’t put our money and attitudes where our mouth is.

      • Exercise could be a large factor but on diet and obesity consider the following:

        • From that link “They only looked at mortality. They didn’t look at morbidity or disability associated with obesity,”

          Also, if memory serves, exercise is more important that diet or weight in terms of mortality and morbidity.

    • Tobacco easily adds another $30 billion to the tab.

      I have long heard that tobacco does not increase life time medical spending because people die quickly with lung cancer and heart disease. Shorter life is of course a cost not a benefit but presumably smokers enjoy smoking.