The Human Cost of Substance AbuseThe Human Cost of Substance AbusePresentation by Mel Taylor, MSWPresentation by Mel Taylor, MSW

July 2005July 2005

THE MAGNITUDE OF THE PROBLEM

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:

TobaccoTobacco - 430,700 deaths

AlcoholAlcohol - 100,000 deaths

Illegal drugsIllegal drugs - 16,000 deaths

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 alcoholalcohol

1/5 (20%) involved cocainecocaine

MarijuanaMarijuana was involved in about the same number of cases as cocaine

Other drugs involved in ER visits were PCP, Ecstasy, Heroin, Amphetamines/Methamphetamines

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.

In this statewide study,

Less than 10 percent of the emergency department patients needing substance abuse treatment were currently receiving it.

"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%

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.

The costs of ATOD are staggering

Over $414 billion dollars per year for health care services, lost productivity, crime, and destruction of property.

Alcohol abuse alone costs nearly $166 billion each year.

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.

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 +[//]

Alcohol-use disorders are the leading cause of injury. 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.

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 +[//]

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 +[//]

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.

Results:

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 +[//]

If interventions were routinely offered If interventions were routinely offered to eligible injured adult patients to eligible injured adult patients nationwide, the potential net savings nationwide, the potential net savings could approach $1.82 billion annually. could approach $1.82 billion annually.

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. 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.

Patients receiving intervention drank an average of 22 fewer drinks

White Paper, Katie McQeen, et. al

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

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

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.

The study found that more than 30 percent of depressed women and men visiting primary care doctors had drug or alcohol problems.

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 Majority of People Who Need Treatment for Drug Abuse Problems

Don’t Receive It!

The Majority of People Who Need Treatment for Drug Abuse Problems

Don’t Receive It!

001010202030304040

5050606070708080

9090100100

19911991 19921992 19931993 19941994 19951995 19961996 19971997 19981998

% N

otT

reat

ed

% N

otT

reat

ed

Source: OAS, SAMHSA. Unpublished Data from the National Household Survey on Drug Abuse and UniformFacility Data Set (1991-1998) – in National Drug Control Strategy 2000 Annual Report Table 39, p. 140.Source: OAS, SAMHSA. Unpublished Data from the National Household Survey on Drug Abuse and UniformFacility Data Set (1991-1998) – in National Drug Control Strategy 2000 Annual Report Table 39, p. 140.

68%68%62%62% 61%61%

57%57%54%54%

63%63% 63%63%57%57%

00 2020 4040 6060 8080 100100

Senile cataractBreast cancerPrenatal care

Low back painCAD

HypertensionCongestive heart failureCerebrovascular disease

COPDDepression

Orthopedic conditionsOsteoarthritis

Colorectal cancerAsthma

Benign prostatic hyperplasiaHyperlipidemia

Diabetes mellitusHeadache

UTICommunity-acquired pneumonia

STDsDyspepsia and peptic ulcer disease

Atrial fibrillationHip fracture

Alcohol dependence

Senile cataractBreast cancerPrenatal care

Low back painCAD

HypertensionCongestive heart failureCerebrovascular disease

COPDDepression

Orthopedic conditionsOsteoarthritis

Colorectal cancerAsthma

Benign prostatic hyperplasiaHyperlipidemia

Diabetes mellitusHeadache

UTICommunity-acquired pneumonia

STDsDyspepsia and peptic ulcer disease

Atrial fibrillationHip fracture

Alcohol dependence

Percentage of Recommended Care ReceivedPercentage of Recommended Care Received

Source: McGlynn, E.A., NEJM, 348, pp. 2635-2645, June 26, 2003Source: McGlynn, E.A., NEJM, 348, pp. 2635-2645, June 26, 2003

• 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.

Implications

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.