States Pick Wrong Targets For Substance Abuse Dollars

A comprehensive new analysis of state budgets reveals that of the total taxpayer dollars spent on problems related to substance abuse and addiction during 1998, only 4 percent was spent on treatment and prevention, while 96 percent was spent on cleaning up the damage from substance abuse.

In a three-year look at the costs to states of substance abuse and addiction conducted by the National Center on Addiction and Substance Abuse at Columbia University (CASA), it was found that in 1998, states spent about $81 billion on substance abuse and addiction, approximately 13.1 percent of their total budgetary outlay. Of each dollar spent on substance abuse and addiction, the study showed that 96 cents was spent on “shoveling up the wreckage of substance abuse and addiction” (totaling $77.9 billion), while only 4 cents went to prevent or treat the growing problem (totaling only $3 billion).

The authors of the 183-page report, “Shoveling Up: The Impact of Substance Abuse on State Budgets,” point out that their study is the first to look at the impact of all substance abuse, including alcohol, tobacco, and illicit drug use, on state budgets.

The study also found that states varied widely on the proportion of their total spending dedicated to prevention and treatment efforts rather than to repairing the damage. South Dakota led the states in this area, spending just over 10 percent of its substance abuse and addiction outlay on prevention and treatment, while Colorado spent only .06 percent on prevention and treatment.

“Substance abuse and addiction is the elephant in the living room of state government,” said Joseph A. Califano Jr., president of CASA and a former secretary of the U.S. Department of Health, Education, and Welfare. Califano, speaking at a press conference January 29 to announce the results of the study, said the damage wreaked by substance abuse and addiction creates havoc with service systems; causes illness, injury, and death; and consumes increasing amounts of each state’s resources.

“This report,” Califano declared, “is a clarion call for a revolution in the way governors and state legislators think about and confront substance abuse and addiction.”

In its study, CASA looked at 16 areas of state spending, including the criminal and juvenile justice systems, transportation, health care, education, and the child and adult welfare systems, to see how tax dollars were spent to deal with problems traced to substance abuse.

CASA found that the $77.9 billion spent on “damage control” in 1998 was used in these ways:

• $30.7 billion was spent in the justice system;

• $16.5 billion was spent in the education system;

• $15.2 billion was spent on health care;

• $7.7 billion was spent on child and family assistance;

• $5.9 billion was spent for mental health and developmental disability programs;

• $1.5 billion was spent on public safety; and

• $400 million was spent to hire additional personnel in the states’ workforce to deal with these issues.

“Every sector of society spends hefty sums of money shoveling up the wreckage of substance abuse and addiction,” said Califano. “Nowhere is this more evident than in the public spending by the states.” If states want to reduce child abuse, teen pregnancy, and domestic violence and further reduce welfare roles, Califano said, they must face up to the reality that “unless they prevent and treat alcohol and drug abuse and addiction, their other well-intentioned efforts are doomed.”

CASA distributed an exhaustive survey to the budget offices of each state. Forty-five states responded, along with the District of Columbia and Puerto Rico. The report, however, covers only state-incurred costs. It does not cover federal matching funds, for example, those earmarked for Medicaid and welfare, or include outlays by the federal government, local governments (which cover the majority of costs for law enforcement), and parochial or private schools. CASA is, however, conducting studies that will provide data in these areas.

The CASA report offers detailed recommendations on targeting treatment and prevention efforts using states’ legislative and regulatory powers and on improving program management and service delivery.

“Energetic, effective, and comprehensive efforts to prevent substance abuse and addiction and to treat those who fall prey to these problems hold the promise of freeing up billions of dollars of state funds for other pressing needs and reducing the burden of taxpayers,” Califano said.

Richard Suchinsky, M.D., chair of APA’s Council on Addiction Psychiatry, agreed with the general conclusions of the report, although he believes that the report may have a marginal effect in helping to persuade those who hold the purse strings to re-evaluate their priorities. “It costs some $50,000 to $75,000 a year to keep someone locked up, but only a small fraction of that to provide appropriate substance abuse treatment,” he said.

“It really is incumbent,” Suchinsky told Psychiatric News, “not only on political types but also on psychiatry as a whole to really look at what has occurred over the last 20 or so years. Prisons and jails are the new mental health treatment facilities. With increasingly common closures of both inpatient and outpatient mental health facilities, those with substance abuse problems or other psychiatric illnesses have been diverted either to the streets or behind bars. Although treatment outside a supportive system, such as a hospital, has great benefits for some, it has great detriments for a far larger number of patients.”

“Shoveling Up: The Impact of Substance Abuse on State Budgets” may be ordered online at www.casacolumbia.org by clicking on “Publications” and then the report title. The cost is $15. ▪