238 



In addition, while many had argued that the effects of these substances on disease 

 were long-term, and the results of efforts to control abuse and addiction would not be seen for 

 many years, the CASA study found the opposite to be the case. In fact, two-thirds of the costs 

 of substance abuse to Medicaid were related to short-term health problems including those 

 associated with trauma, AIDS and birth complications, where the impact on health can be seen 

 abnost immediately. Efforts to control the use of these substances can lead to immediate 

 savings to the health care system. 



The current phase of CASA's work deals with the impact of substance abuse on the 

 use of inpatient hospital services under Medicare. As suggested in a recent study reported in 

 the Journal of the American Medical Association^ which examined alcohol-related 

 hospitalizations in the elderly, the costs of alcohol abuse to Medicare can be significant. But, 

 when all substances— as well as all the health problems related to them~are considered, the 

 costs to Medicare are astronomically higher: more than 50 times as much as was estimated in 

 that earlier study. Using the methodology from the previous CASA study of Medicaid 

 (described in Appendix I), but accounting for the differential impact of these substances on the 

 elderly, as with Medicaid, substance abuse proved to be a major contributor both to morbidity 

 and to the costs of health care for the elderly and disabled. 



