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which substance is the real culprit. In either case, whether as a result of alcohol or drugs, or 

 both, the problem of adverse birth outcomes is strongly associated with substance abuse. 



Chart 4 breaks down the short- and long-term impact of substance abuse on morbidity. The 

 $2.93 billion total in Chart 4 does not add to the total in Chart 1, since Chart 4 includes only 

 costs related to substance abuse as a risk factor in other conditions and does not take into 

 account substance abuse as either a secondary diagnosis or a direct treatment cost. The reason 

 for including this table is to note that reductions in substance abuse can have a real and 

 immediate impact on costs. In the case of birth outcomes, trauma, AIDS, and strokes among 

 younger people, reducing substance abuse can have a significant immediate effect on health 

 spending. By contrast, in the case of diseases like lung cancer, where the disease is acquired 

 through long term abuse of a substance, reducing current substance abuse will not immediately 

 affect health care costs ~ the savings would be accrued over time as less people in the future 

 acquire those diseases. 



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