The Human Cost of Substance Abuse

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The Human Cost of Substance Abuse Presentation
by Mel Taylor, MSW July 2005
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THE MAGNITUDE OF THE PROBLEM
Of the more than 2 million deaths each year in
the US, approximately one in four is attributable
to alcohol, tobacco and/or illegal drug use
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Tobacco - 430,700 deaths Alcohol - 100,000
deaths Illegal drugs - 16,000 deaths
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DAWN (Drug Abuse Warning Network)
For the third and fourth quarters of 2003, DAWN
estimates 627,923 drug-related ER visits in the
US. For Q2-Q3 of 2003 DAWN estimates 305,731
drug-related ER visits involved substance of
abuse. Nearly 50 of these visits involved
alcohol 1/5 (20) involved cocaine Marijuana
was involved in about the same number of cases as
cocaine Other drugs involved in ER visits were
PCP, Ecstasy, Heroin, Amphetamines/Methamphetamine
s
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Researchers led by Ian Rockett, PhD, from West
Virginia University's Department of Community
Medicine and Center for Rural Emergency Medicine
found that emergency department patients with
unmet substance abuse needs are 81 more likely
to be admitted during their emergency visit and
46 more likely to have reported making at least
one emergency department visit in the previous 12
months. Their utilization of emergency medical
services accounted for 777.2 million in extra
hospital charges for Tennessee in year 2000,
representing an additional 1,568 for each
emergency patient with unmet substance abuse
treatment needs.
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In this statewide study, Less than 10 percent
of the emergency department patients needing
substance abuse treatment were currently
receiving it.
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"Frequent Emergency Room Visits Signal Substance
Abuse and Mental Illness, Washington State's
Aged, Blind, and Disabled Clients" Publication
Date 1/2004. Report Number 11.119. (110 KB) Nine
out of ten aged and disabled clients who visited
the emergency room 31 or more times in FY 2002
had a substance abuse disorder, a mental illness,
or both. Furthermore, clients who visit the
emergency room frequently use large quantities of
prescription narcotics and few of these clients
with substance abuse disorders receive treatment
for that condition.
90
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The costs of ATOD are staggering
Alcohol abuse alone costs nearly 166 billion
each year.
The Center on Addiction and Substance Abuse at
Columbia University estimates that in 1998 states
spent 13 of their budgets on direct and indirect
costs attributable to the use of alcohol,
tobacco, and other drugs (ATOD) contrast this
with the 11 spent for the entire Medicaid budget
and the 13 spent on higher education.
Over 414 billion dollars per year for health
care services, lost productivity, crime, and
destruction of property.
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Alcohol, tobacco, and other drugs are responsible
for more preventable deaths in this country than
any other health problem. In 1996, nine million
children lived with a parent who was dependent on
alcohol or illegal drugs. According to the Texas
Commission on Alcohol and Drug Abuse (TCADA)
The economic burden of ATOD in Texas in 1997 was
19.3 billion dollars. That is a per capita cost
of 1,001 for every man, woman, and child.
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Alcohol-use disorders are the leading cause of
injury.
Brief interventions in trauma patients reduce
subsequent alcohol intake and injury recidivism .
. . . . . but have not yet been widely
implemented.
Alcohol Interventions for Trauma Patients Treated
in Emergency Departments and Hospitals A Cost
Benefit Analysis. Annals of Surgery.
241(4)541-550, April 2005.Gentilello, Larry M.
MD Ebel, Beth E. MD, MPH // Wickizer,
Thomas M. MPH, PhD Salkever, David S. PhD
S Rivara, Frederick P. MD, MPH //
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The study population consisted of injured
patients treated in an emergency department or
admitted to a hospital.
Alcohol Interventions for Trauma Patients Treated
in Emergency Departments and Hospitals A Cost
Benefit Analysis. Annals of Surgery.
241(4)541-550, April 2005.Gentilello, Larry M.
MD Ebel, Beth E. MD, MPH // Wickizer,
Thomas M. MPH, PhD Salkever, David S. PhD
S Rivara, Frederick P. MD, MPH //
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Results
An estimated 27 of all injured adult patients
are candidates for a brief alcohol intervention.
The net cost savings of the intervention was 89
per patient screened, or 330 for each patient
offered an intervention.
The benefit in reduced health expenditures
resulted in savings of 3.81 for every 1.00
spent on screening and intervention.
Alcohol Interventions for Trauma Patients Treated
in Emergency Departments and Hospitals A Cost
Benefit Analysis. Annals of Surgery.
241(4)541-550, April 2005.Gentilello, Larry M.
MD Ebel, Beth E. MD, MPH // Wickizer,
Thomas M. MPH, PhD Salkever, David S. PhD
S Rivara, Frederick P. MD, MPH //
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If interventions were routinely offered to
eligible injured adult patients nationwide, the
potential net savings could approach 1.82
billion annually.
Alcohol Interventions for Trauma Patients Treated
in Emergency Departments and Hospitals A Cost
Benefit Analysis. Annals of Surgery.
241(4)541-550, April 2005.Gentilello, Larry M.
MD Ebel, Beth E. MD, MPH // Wickizer,
Thomas M. MPH, PhD Salkever, David S. PhD
S Rivara, Frederick P. MD, MPH //
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There are roughly 2000 alcohol and drug-related
deaths that occur in Harris County each year.
Utilizing best practices in screening,
intervention, and treatment of ATOD disorders
leads to a general improvement in work and
relationships, less involvement with law
enforcement, reduced substance use, and a 60-85
reduction in medical problems. In a Level I
trauma center in Seattle, 46 of all trauma
visits screened positive for an alcohol problem.
a week and there was nearly a 50 reduction in
trauma after 12 months.
Patients receiving intervention drank an average
of 22 fewer drinks
What if the incidence of alcohol misuse in the
BTGH Level I trauma patients was the same as in
the Seattle patients? An intervention would
reduce drinking and subsequent trauma in 9,000
patients.
White Paper, Katie McQeen, et. al
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In family practice centers in Galveston, the
percentage of patients with alcohol misuse ranged
from 8 for African American women to 22.5 for
Hispanic men. Additionally, Project TrEAT
demonstrated significant reductions in drinking
leading to decreased healthcare and legal costs
(average economic benefit 946.00 per patient)
in patients who received two fifteen-minute
sessions with a physician addressing drinking
behavior and consequences and urging them to cut
down or quit.
White Paper, Katie McQeen, et. al
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What if the cost-benefit of brief intervention
were the same at HCHD as in Project TrEAT and the
incidence of alcohol misuse was the same as in
Galveston Clinics? 12,269 patients would be
detected by screening! 11,606,474 would be
saved in medical costs, crime, and MVAs by
intervention!
HCHD would save 5,338,978!
White Paper, Katie McQeen, et. al
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In a new study, which was supported in part by
the Agency for Healthcare Research and Quality
(HS08349), the researchers analyzed data from a
large survey of 46 managed care clinics in 5
States that were participating in a study to
improve quality of care for depression.
Yet only 8 percent of these patients, mostly
men, had been counseled about drug or alcohol use
during their most recent primary care visit.
The study found that more than 30 percent of
depressed women and men visiting primary care
doctors had drug or alcohol problems.
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Implications

• More can be done and enormous benefits can be
  derived for very little increase in expenditures.
• A detox facility centrally located or part of
  NPC or HCPC could help divert many patients from
  ERs and certainly reduce frequent flyers.
• Coordination between existing entities case
  management has proven its effectiveness in
  Harris County in addressing dual disorders needs.
• The chemical dependency prevention and treatment
  network is cohesive, has a central intake and
  monitoring system, and is effective.
• Much of the issues surrounding chemical
  dependency are preventable and with early
  intervention problems are greatly reduced and at
  a much lower cost.

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Finally, substance abuse issues are more
frequently seen and more easily documented than
most mental health issues, and if addressed also
address many mental health issues. Thus it makes
sense to include chemical dependency counselors
at the front door.