184 



Impact of Substance Abuse and Addiction on Health Care 



Substance abuse and addiction is not confined to one Ulness. Its costs to the system go well 

 beyond what is spent on direct treatment. Substance abuse is ubiquitous, reaching every comer 

 of health care from ailments such as cancer and cardiovascular disease to trauma, birth 

 complications and AIDS. Substance addiction and abuse is the sole cause for diseases such as 

 alcohol cirrhosis and fetal alcohol syndrome. It is also a major risk factor for other costly health 

 problems, including lung cancer and coronary heart disease. It complicates all sorts of otherwise 

 unrelated diseases and ailments, such as severe bums and pneumonia, adding days and dollars 

 to treatment. 



Estimates vary about the total direct and indirect cost of substance abuse to the health care 

 system: they run as high as $140 billion a year and, thus, represent a significant portion of the 

 total health care bill. Whatever the cost, it is clear that achieving meaningful health care reform 

 win be difficult without addressing the problem of substance abuse. 



Substance abuse affects health care expenditures in both the long-term and the short-term. What 

 we are seeing in health care expenditures, including Medicaid's, is the result of the cumulative 

 effects of using and abusing substances over many years. This leads to illnesses such as heart 

 disease and cancer. However, some costs stem from the more immediate medical effects of 

 substance abuse — birth complications, injuries resulting from violence and accidents, AIDS, and 

 strokes among younger people who overdose on drugs. Reducing the longer-term costs is 

 important, but these shorter-term costs have special relevance in the context of health care 



