212 



of the age range from 21 to 64 only when they have a serious and pennanent disability, the 

 "undesirable" hypothesis described previously may explain this, since this group includes those 

 with chronic alcohol or drinking problems as well as those diagnosed as having both mental 

 illness and chemical dqwndency problems. Hospitals may stabilize these individuals and then 

 discharge or transfer them quickly to nursing homes or psychiatric facilities, accounting for their 

 shorter length of stay. 



According to Chart 12, babies bom to mothers who abuse substances during pregnancy remain 

 almost three times longer in the hospital than babies bom to mothers who did not abuse 

 substances. In utero substance abuse exposure often results in low birth weight, premature 

 delivery, and its sequelae, mental retardation, and congenital malformations. Here again, the 

 difference in ALOS does not include the effect of smoking during pregnancy, which would likely 

 make these differences even more dramatic since smoking is associated with low birth weight 

 and other adverse effects. 



Chart 13 reveals that AIDS patients with substance abuse as a secondary diagnosis stay about 

 one-third longer than those without this diagnosis. Nationwide, 32 % of all adult and 55 % of 

 aU pediatric AIDS cases are attributable to intravenous dmg use. Considering that AIDS is a 

 protracted disease that may take ten years or more to run its course and involves multiple 

 hospital stays, the total impact of even a third longer length of stay has significant cost 

 implications. 



Medicaid patients with a primary diagnosis of bums, pneumonia, or septicemia and a secondary 

 diagnosis of substance abuse stay more than twice as long in the hospital as Medicaid patients 

 with the same primary diagnosis but no substance abuse (Chart 14). For example, bum patients 

 with a secondary diagnosis of substance abuse have an ALOS of 12.6 days compared to 5.6 days 

 for bum patients without the secondary diagnosis. 



