Summary/Abstract

Drug overdoses are the leading cause of injury death in the United States, and substance use disorders are among of the most prevalent illnesses even though they are chronic diseases that can be effectively prevented and treated.

Content

Substance use  costs over 100,000 lives and upwards of a half of a trillion dollars annually, harming families and communities across the country.  On top of high rates alcohol, cocaine and other drug problems, an epidemic of prescription opioid and heroin misuse is sweeping the nation.  In the 2014 annual survey of top health concerns conducted by the C.S. Mott Children’s Hospital National Poll on Children’s Health, adults across the nation rated drug abuse as the 3rd leading health concern for children in their communities; alcohol abuse came in 6th. If alcohol and drug abuse are combined, they easily come in first as the top health concern for children.

Substance use disorders are preventable and treatable, just like hypertension, diabetes, and asthma. A large body of evidence shows that treatment for substance use disorders is effective and results in remarkable cost savings to the health care, criminal justice, child welfare and social services systems. Substance use disorder treatment has been shown to cut drug use in half, reduce crime by 80 percent, and reduce arrests by up to 64 percent. Evidence-based educational programs and environmental changes have significantly reduced underage drinking.  Between 2002 and 2013, for example, current alcohol use among underage people (aged 12-20) declined from 28.8 percent to 22.7 percent, a drop of over 20% of the previous 2003 level.

There is a tremendous unmet need for substance use prevention, treatment and recovery services.

According to the most recent National Survey on Drug Use and Health (NSDUH) from the Substance Abuse and Mental Health Services Administration (SAMHSA), 21.5 million Americans aged 12 or older needed treatment for an alcohol or illicit drug problem in 2014 but only 2.3 million received substance use treatment.

The Institute of Medicine identified alcohol and other drug use in the armed forces as a public health crisis. The report found that there is substantial unmet need for substance use disorder treatment services as well as outdated policies and practices that serve as barriers to care.

Federal data show that in a given month, as many as 6.5 million Americans misuse prescription drugs. The Centers for Disease Control and Prevention has found that narcotic painkiller overdoses kill 44 people every day in the United States, more than heroin and cocaine combined.

The costs of untreated substance use disorders to the healthcare system are immense and growing.

According to the Agency for Health Research Quality, 25 percent of U.S. hospital admissionsare directly related to mental health and/or substance use disorders.  Patients with alcohol problems spend an average of four times as many days in the hospital as non-drinkers, mostly because of drinking-related injuries. The estimated annual health care expenditures for alcohol and illicit drug use is over $35 billion. Untreated alcohol and drug addiction canaggravate or mask symptoms of medical conditions and complicate treatment effectiveness. More than 5 million emergency department visits a year are associated with drug use.

Addressing SUD through a health lens will result in huge cost-savings to the health care system

While the costs of untreated substance use disorders are enormous, evidence demonstrates that prevention and treatment of SUD results in significant cost-savings.  For example:

• Inpatient, emergency room, and total healthcare costs decline by 39 percent, 35 percent, and 26 percent respectively after patients who suffer from alcohol or drug addiction receive treatment.
• For patients with SUD-related medical conditions, integrating medical and SUD treatment services results in decreases in hospitalization rates, fewer days of inpatient treatment, and fewer emergency room visits. Total medical costs per patient per month are more than halved, from $431 to $200.
• A Washington State study of the impact of a 2005 investment by the state in SUD treatmentestimates a return on investment of 2:1 over the next four years in direct healthcare related costs; that is, for every dollar invested in expanded alcohol and drug dependence treatment the state saved at least two dollars in avoided medical and nursing facility costs.
• A similar Washington State study concluded that much, if not all, of the cost to the state of providing SUD treatment to low-income adults is offset by increased earnings and the associated contributions to the state general fund, reduced medical costs among those who enroll in Medicaid, and reduced costs associated with fewer arrests.
• According to a recent study by SAMHSA, every dollar spent on school-based substance use prevention efforts produces $18 in savings related to health, work loss, and other social costs.

Ensuring that justice-involved individuals can access public benefits, housing, health care, education and employment will improve health and public safety, reduce crime and disease, and save money

A criminal conviction exposes a person to barriers that make it more difficult to participate in educational opportunities, obtain employment, maintain suitable housing, receive quality healthcare, and access public benefits. Yet research shows that these are the very things that make successful reentry more likely.  For example:

• In addition to its practical function as a credential in the job market, participation in higher education has been shown to lower recidivism by 15% and 13% for people who earn an associate’s or bachelor’s degree, respectively. By investing in post-secondary education for incarcerated people, the Correctional Education Association calculated that states experience a “return [of] at least $2 for every $1 spent in terms of saving in cell space on those who do not return to the system.”
• A study by the American Bar Association Commission on Effective Criminal Sanctions shows that people with criminal records who are unable to obtain employment are three times more likely to return to prison than those individuals who are able to find work.
• Stable housing is a critical component of successful reentry.  Research indicates that both supportive housing and peer-led recovery residences are associated with reductions in recidivism.
• A Yale Center for Interdisciplinary Research on AIDS study found that people with drug convictions who are denied government food benefits upon release from prison are “at greater risk of engaging in dangerous, sexual risk behaviors in order to obtain food” and that37% had gone an entire day without food in the past month. 25% reported that their children had similarly gone without food for an entire day. Other research shows that children who are denied public assistance are at greater risk of hospitalization and food insecurity.