Page: 1  2  3

Alcohol, tobacco and illicit drugs threaten the health of individuals who do not even use them. They also add significantly to California's health care costs. Substance abuse is a major factor in chronic disease, the spread of infectious diseases, hospital emergency room visits, newborn health problems, violence and auto fatalities.

Death, Disease and Substance Abuse. Smoking kills more people every year nationwide than AIDS, drugs, alcohol, motor vehicle collisions, homicides and suicides combined. Although smoking rates are down in California, it will be many years before declines in smoking are reflected in reductions in smoking deaths and disease. About 42,000 Californians die each year from diseases caused by smoking, 13,600 from lung cancer alone. Tobacco-related health problems include heart disease and respiratory problems in both smokers and those who inhale secondary smoke.

Since 1988, about 13,000 people in California have died from alcohol-related causes. Drunk driving deaths have fallen 35 percent, from 2,711 in 1988 to 1,760 in 1993. The number of alcohol-related injuries in the state dropped 33 percent.

Diseases of the liver, pancreas and heart are common for alcohol abusers. Chronic liver disease causes almost 4,000 deaths per year.

Drug-related deaths in California increased 40 percent from 1991 to 1993. Of the 2,800 drug deaths in 1993, 68 percent were overdose deaths, while 10 percent were homicides.

The number of methamphetamine-related deaths more than doubled between 1991 and 1994. Sixty percent of methamphetamine overdose deaths are in people over age 35. Illicit drug use can also cause serious medical problems and impose additional burdens on medical services. In 1993, Los Angeles recorded more than 19,300 drug-related emergency-room visits; San Francisco, 10,400 visits; and San Diego, 4,900 visits. While these figures have been declining in all three cities, they give an indication of the extent of the health risk posed by illicit drug use.

Tuberculosis, AIDS and Sexually Transmitted Diseases. Tuberculosis (TB) has made a recent comeback across the nation. TB is an infectious disease spread by airborne droplets expelled when a person with active tuberculosis coughs or sneezes. The Centers for Disease Control and Prevention reports that individuals with a significantly suppressed immune system (due to poor health, chronic abuse of alcohol or drugs, old age, chemotherapy for cancer, or HIV infection) are at increased risk for tuberculosis. There are only a few settings where the incidence of active TB may be cause for special concern, such as health care facilities, correctional institutions and drug treatment centers. In 1994, there were 4,860 TB cases in California, 20 percent of all cases nationwide. According to the California Tuberculosis Control Branch, 16 percent of the TB cases in 1994 occurred in individuals who reported drug and alcohol abuse within the past year, up from 14 percent in 1993.

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) can be deadly consequences of substance abuse. Injection drug users who share needles can contract HIV, and also transmit the virus to their sex partners and unborn children. In 1994, drug-related cases accounted for 20 percent of the new adult AIDS cases reported in California, up from 15 percent in 1990.

However, this is significantly lower than the national rate of 36 percent of new AIDS cases resulting from injection drug use, reported in 1994. The number of new AIDS cases among women and children continues to increase in California. However, injection drug use appears to be a less prevalent transmission route now than in the past. In 1990, drug use was a factor in 67 percent of new pediatric cases and 50 percent of new female cases; this compares to 29 percent and 37 percent in 1994. By contrast, drug use is rising as an exposure factor for men.

Alcohol and drug abuse are also linked to risk-taking behaviors that increase the spread of sexually transmitted diseases. Alcohol and drugs can stimulate sexual activity and reduce inhibitions. Reported cases of congenital syphilis babies born with the disease soared in California from 121 cases in 1988 to 719 cases in 1991, and then declined to 402 cases in 1992. The Centers for Disease Control and Prevention has linked this increase in syphilis to the cocaine epidemic in the 1980s.

California invests significant resources in alcohol and drug abuse treatment. Recognizing the state s enormous geographic, ethnic and economic diversity, counties have been given considerable discretion in meeting the treatment needs of their regions.

In 1993, there were 79,259 drug treatment admissions and 63,622 alcohol treatment admissions to publicly funded programs in California. Injection drug use accounted for 59 percent of the drug treatment admissions in 1993. Forty-five percent of California's treatment admissions are for alcohol abuse, the highest rate of all the western states. Women are receiving an increasing portion of state funded alcohol abuse treatment: 35 percent of admissions in 1993 were women, compared to 25 percent in 1992. Women have accounted for about 40 percent of drug abuse treatment admissions since 1990. California has responded swiftly to the demand for women's services, allocating approximately $51 million to fund 207 new treatment programs for women from 1991 through 1994.

Drug and alcohol abuse by pregnant women causes fetal alcohol syndrome, premature birth, low birth weight and developmental delays, and increases the risk of serious pediatric complications. In a comprehensive study on alcohol and drug use during pregnancy, ADP showed that early prenatal intervention can significantly reduce positive drug toxicologies in newborns. The findings are based on Options for Recovery, a multi-site, pilot intervention program which served chemically dependent pregnant, postpartum and parenting women from 1991 to 1993.

Jointly developed and implemented by four departments within the Health and Welfare Agency (Alcohol and Drug Programs, Developmental Services, Health Services and Social Services), Options for Recovery had sites in Alameda, Contra Costa, Harbor UCLA, South Central Los Angeles, Sacramento, San Diego and Shasta counties. It served over 8,000 women and 18,000 children, and increased knowledge about treatment for pregnant substance abusers. Certain factors contributed to successful treatment: being under age 20, completing high school, being court ordered to treatment, completing at least 5 months of treatment, prior treatment experience, and intensive treatment programs all predicted treatment success. Overall, 77 percent of pregnant women entering Option for Recovery before their third trimester had drug-free babies. This compared to 52 percent of women who entered the program during their third trimester. The children of women in Options for Recovery also spent on average five months less in foster care.

Despite these advances, there are waiting lists for treatment in California just as there are across the country. ADP's records of treatment access show that in a given month, treatment demand out paces treatment slots by a 19 percent margin: waiting lists could fill 8,000 more treatment slots than are currently available (42,500). Waiting lists are longest for residential detoxification and intensive residential treatment; the waiting lists could fill another 50 percent of the 6,250 slots. The shortest wait is for outpatient treatment and outpatient detoxification services; nearly all who request these are served. Estimates of treatment demand may be somewhat inflated since those awaiting treatment may be on more than one waiting list. On average, Californians outside the criminal justice system wait 25 days before being admitted into treatment.

States have the option of including substance abuse treatment among Medicaid benefits. California's Medi-CAL program offers such treatment. ADP licenses and certifies California's alcohol and drug treatment facilities, including Medi-CAL-funded programs. In response to recent expansion in drug Medi-CAL availability, the Fiscal Year 1995-96 budget provides a six-point plan to modify the Medi-CAL drug treatment benefits to assure cost containment. Since most residential services are not reimbursed by Medi-CAL, California and its counties are reevaluating the structure and cost of available services and rethinking strategies for providing treatment.

In 1994 California produced a long range analysis of treatment costs and benefits: The California Drug and Alcohol Treatment Assessment (CALDATA). This study of the cost effectiveness of alcohol and drug treatment in California was the first of its kind to use a scientific sample. The careful design of the study has made the results generalizable to the entire service delivery system. CALDATA has been widely disseminated and its findings presented to Congress and to many state legislative bodies. CALDATA focused on 3,000 participants in residential and outpatient programs of all types in the state. The study found significant reductions in hospitalizations, crime and substance abuse among people interviewed an average of 15 months following treatment. Treatment also led to increased access to disability services and to overall improvements in health status. Finally, longer time spent in treatment had a positive impact on employment, particularly for those in residential programs.

Substance abuse reaches deep into taxpayers pockets, increasing the costs of health care, criminal justice and other services. Beyond these direct expenditures, there are indirect costs, such as lost productivity and absenteeism. Add to these figures law enforcement, prosecution and incarceration costs due to drug-related crimes, and the burden on public coffers becomes immense. In California, the estimated total costs of substance abuse exceeds $25 billion annually.

Treatment Costs. State expenditures for drug and alcohol services have nearly doubled, from $283 million in 1989 to $380 million in 1993. Treatment expenditures, which now account for 72 percent of these costs, increased 58 percent. These figures represent both an increasing demand for treatment and a commitment by the state to respond to those needs. In Fiscal Year 1995-96, 57 percent of prevention, treatment and recovery funds came from federal block grants ($192 million), 25 percent from state general funds and 18 percent from other sources (including Medi-CAL matching funds, special project dollars, and demonstration and federal discretionary grants).

CALDATA concluded that the long-term savings from treatment far outweigh its costs. For every dollar that California spent on substance abuse treatment between October 1991 and September 1992, the state saved $7 in reduced crime and health care costs. Criminal activity declined by over two-thirds among those in the study, and greater time spent in treatment resulted in sharp reductions in criminal involvement and associated costs to the state. Hospitalizations, emergency room visits and other health costs were also reduced by a third after treatment. These savings were true for men and women of all age groups and ethnic backgrounds. Longer treatment stays were more likely to lead to employment and self-sufficiency. A major outcome measure used in CALDATA was the cost to taxpayers of substance abuse and its treatment. CALDATA reported a net savings in taxpayer burden as a result of treatment a savings of $27.40 per client for each day in treatment, and $20 per client for each day after treatment. Some types of treatment resulted in larger taxpayer savings after treatment, particularly residential treatment ($47.35 saved per day) and methadone ($30.47 saved per day).

$7 Saved for Each $1 Spent on Treatment.

Costs of Smoking. Cancer, heart disease and respiratory illness related to smoking result in enormous health care costs, as well as lost productivity and reduced quality of life. Direct health expenditures for smoking-related illnesses in California cost $3.6 billion in 1993, a 52 percent increase over 1989 ($2.4 billion). The indirect costs of smoking in California (including lost wages and lost productivity) were estimated at $6.4 billion in 1993, up from $5.3 billion in 1989. Total costs per smoker exceeded $2,000 in 1993, or about $335 for each state resident.

Costs of Driving Under the Influence. According to the National Highway Traffic Safety Administration, the total cost of an alcohol-related traffic fatality averages $755,333, including direct costs from health care, insurance and property damage. With 2,711 alcohol- related highway deaths in 1988, the direct cost in California was $2 billion. By 1993, the number of alcohol-related traffic fatalities dropped to 1,760, with associated direct costs of $1.3 billion. Estimates of indirect costs vary, as they include projections for lost wages, lost productivity and years of life lost.

Page: 1  2  3