• Substance use: America’s number one health behavior problem — ctd, more

    From CASA’s Shoveling Up II: The Impact of Substance Abuse on Federal, State and Local Budgets:

    If substance abuse and addiction were its own [federal] budget category, it would rank sixth in size–behind social security, national defense, income security, Medicare and other health programs. […]

    If substance abuse and addiction were its own [state] budget category, it would rank second behind elementary and secondary education. States spend more on substance abuse and addiction than they spend on Medicaid, higher education, transportation or justice. […]

    For every dollar federal and state governments spent to prevent and treat substance abuse and addiction, they spent $59.83 in public programs shoveling up its wreckage.

    Maybe I’m naive, but I was not aware how big a draw on budgets substance abuse was. And, it is probably underfunded relative to the problem. Are we talking about this health behavior enough?

     

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    • The cost of the drug war (interdiction, law enforcement, imprisonment) accounts for a large part of the economic impact of substance abuse. In a recent lit review, the best estimates I could find were from a couple of government reports:

      Miller, Ted R. and Hendrie, Delia. Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis, DHHS Pub. No. (SMA) 07-4298. Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, 2008. Available at: http://store.samhsa.gov/shin/content//SMA07-4298/SMA07-4298.pdf.

      Office of National Drug Control Policy (2004). The Economic Costs of Drug Abuse in the United States, 1992-2002. Washington, DC: Executive Office of the President (Publication No. 207303). Available at: http://www.ncjrs.gov/ondcppubs/publications/pdf/economic_costs.pdf.

      The costs of drug abuse in the DHHS report were attributed as follows: direct costs – 5 percent for addiction treatment and prevention, 4 percent for treatment of medical consequences, 21 percent for crashes, fires, and criminal justice; indirect costs – 31 percent due to lost earnings from premature deaths and disability, 39 percent for lost productivity related to criminal acts.

      In the second report, the costs were broken out in the following categories: direct costs – 9 percent for treatment of medical consequences, 20 percent for other direct costs (the cost of goods and services lost to crime and social welfare costs); indirect costs – 33 percent due to lost earnings from premature deaths and disability and 38 percent for lost productivity related to criminal acts.

      In 2009, the US Federal government budget for illicit drug control was $15.3 billion, in the following categories: 23 percent for treatment (in the form of grants to states), 12 percent for prevention (education and outreach), 25 percent for domestic law enforcement, 26 percent for interdiction (mainly border enforcement), and 14 percent for international drug control efforts.

      I found this book to be interesting reading as well:
      Robinson, Matthew B. and Scherlen, Renee G. Lies, Damned Lies, and Drug War Statistics: A Critical Analysis of Claims Made by the Office of National Drug Control Policy. Albany, NY: State University of New York Press, 2007.