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Despite such limitations, these studies still provide a powerful argument for the inclusion of 

 substance abuse in the cost containment debate. In addition, they demonstrate the need to 

 understand more fully just how critical this issue is if we are to address seriously not only the 

 concerns over the solvency of the Medicare Trust Fund, but health care reform in general. 



The CASA Study 



In 1992, CASA~The Center on Addiction and Substance Abuse at Columbia 

 University—initiated a comprehensive study documenting the full extent to which all substance 

 abuse, including alcohol, drugs and tobacco, contributes to the costs of the health care system. 

 Combining a critical review of the medical and epidemiologic literature linking substance abuse 

 as a risk factor for a wide variety of medical conditions, with extensive consultation with 

 physicians and researchers knowledgeable in this area, CASA is in the process of estimating 

 the magnitude of this problem and its associated costs. 



The first phase of this project, which examined the extent to which Medicaid 

 hospital costs might be attributed directly or indirectly to substance abuse, was completed in 

 July of 1993.'* This study found that at least one in five hospital days under Medicaid, or $7.4 

 billion of Medicaid hospital costs in 1994, could be linked with the use or abuse of alcohol, 

 tobacco or drugs. For diseases and health conditions as disparate as cancer, stroke, heart 

 disease, AIDS, trauma, and birth complications, substance abuse has been documented to be 

 a major risk factor. When these health effects are considered, substance abuse takes a major 

 toll on the Medicaid program. And these estimates are undoubtedly still low because of both 

 the underreporting of the problem and the fact that the available research, particularly for 

 alcohol and drugs, is incomplete in documenting the full impact of substance abuse on 

 morbidity. 



