251 



DRG payment itself— with an implicit limit on the days of covered care— also may work 

 against patients with substance abuse as a complicating factor to another health problem. Far 

 more research is needed in this area. •> , ..^ 



While this study focused on substance abuse in short stay general hospitals. 

 Medicare also pays a significant amount in psychiatric hospital costs. According to a survey 

 of psychiatric hospitals, 15.6 percent of total admissions were for alcohol and drug abuse- 

 related disorders. This does not include cases where another diagnosis may have been recorded 

 or the substance abuse was secondary to a mental health problem. But, applying this 

 percentage to Medicare psychiatric costs, in 1991 Medicare spent an additional $160 million 

 on care for substance abuse in psychiatric hospitals. 



CONCLUSION 



Substance abuse is a pervasive problem that is not limited to one segment of our 

 society. Rather, old and young and rich and poor are all equally vulnerable to its effects on 

 their health. Further, substance abuse cannot be viewed only as a single disease entity, but 

 must be considered as a problem that permeates every aspect of our health system and is a risk 

 factor for all major disease categories. Not only must physicians concerned with addiction 

 medicine address this issue, but all physicians, regardless of specialty, must be aware of the 

 fact that alcohol, tobacco and drugs are a major factor in both causing and complicating the 

 medical problems of their patients. Thus, physicians— as well as other health care 

 professionals-must be both capable of, and willing to identify substance abuse and take the 

 stq>s necessary to address it. This may range from discussions with their patients about their 

 substance abuse problems to referral to appropriate treatment. 



