Recovery Month Kit

OVERVIEW: SAVING LIVES, SAVING DOLLARS

Millions of people nationwide are plagued by the disease of addiction and can benefit from treatment. Treatment for substance use disorders has proven to be cost effective. As people embark on treatment and recovery, mental and physical health improves, and their employment and income level increases.¹ In 2005, as many as 74 percent of Americans said that addiction to alcohol had some impact on them at some point in their lives, whether it was their own personal addiction, that of a friend or family member, or any other experience with addiction.²

A substance use disorder^* (See Glossary near the end of this page for definitions of bolded and starred terms) involves the dependence on, or abuse of, alcohol and/or drugs, including the nonmedical use of prescription drugs. Substance use disorders can affect people regardless of their age, race, ethnicity, class, employment status, or community.³ Therefore, like other chronic physical and mental disorders, substance use disorders are medical conditions that can be treated effectively.^4,5

In striving to make treatment^* more affordable, key stakeholders and members of the community should understand how the cost of substance use disorders compares to other diseases that are commonly invested in. Based on 1990s' estimates that employed comparable methodologies, the total economic cost of the consequences of drug abuse, about $180.9 billion in 2002, was equivalent, if not higher than:

• Heart disease: $183.1 billion
• Cancer: $96.1 billion
• Diabetes: $98.2 billion
• Alzheimers disease: $100 billion
• Stroke: $43.3 billion^6,7

Even when only comparing these diseases to the health-related costs of drug abuse—$51 billion in the 1990s—it still is one of the more costly health problems in the nation.⁸ This underscores the need to elevate the profile of the prevalence of substance use disorders and the importance of investing in treatment.

The following overview addresses the value of investing in treatment, along with the financial and human costs substance use disorders have on individuals, families, and the community. Understanding that these costs can be transformed into societal savings when treatment is available to those in need, along with encouraging people who need treatment to start and continue on a path of recovery^*, can help us all make a difference.

The Value of Investing in Treatment

Research shows that substance use disorders are medical conditions that can be effectively treated, just as many illnesses are treatable.^9,10 A major study published in 2000 in the Journal of the American Medical Association is one of several that demonstrate the effectiveness of treatment for substance use disorders. The study found that treatments for drug use disorders are just as effective as treatments for other chronic conditions, such as high blood pressure, asthma, and diabetes.¹¹

Treatment is offered in different settings, and types of treatment vary based on the substances misused, as well as a persons individual needs and characteristics. Treatment is offered in residential and outpatient programs and can include counseling or other behavioral therapy, family therapy, medication, or a combination of services.^12,13

Different groups of people are often provided with distinct methods of treatment. For example, a family-oriented approach to treatment can be most effective among adolescents with substance use disorders.¹⁴ Older adults with substance use disorders have been shown to respond well to age-specific, supportive, and nonconfrontational group treatment that aims to build or rebuild self-esteem.¹⁵ For more information on treatment, please see "A Guide to Treatment: Methods To Help People With Substance Use Disorders" in this planning toolkit and at www.recoverymonth.gov.

Investing in treatment has many financial and personal benefits for someone in recovery, as well as the larger community. Nationwide, the total expenditure in 2001 for the treatment of substance use disorders in the United States was an estimated $18 billion, and this investment offers numerous benefits to society.¹⁶ In addition to reducing alcohol and/or drug use, treatment can improve mental and physical health and contribute to fewer family problems. Providing treatment for people with substance use disorders is directly related to improvements in the publics health and safety, as well as a reduction in health costs.^17,18

Many studies show a positive return on investment when money is spent on treatment. Research suggests at least a 2:1 benefit-to-cost ratio, with other studies allowing for a return of $7 for every dollar spent on treatment.^19,20 Another study discovered as much as a $23 return for every dollar spent on treatment.²¹ While the return on investment varies from state to state and program to program, evidence supports the overall positive financial gain to society when investing in the treatment of people with substance use disorders. Ensuring Solutions to Alcohol Problems offers an online tool that assists employers in determining the return-on-investment ratio when investing in alcohol screening and treatment for employees. This tool, titled The Alcohol Cost Calculator for Business, is available online at www.alcoholcostcalculator.org/roi/.

Treatment also helps people in the workplace. Of the 20.2 million adults classified with dependence or abuse in 2005, 15.5 million (or 76.7 percent) were employed either full or part time.²² Reported job problems, including incomplete work, absenteeism, tardiness, work-related injuries, mistakes, and disagreements with supervisors, are cut by an average of 75 percent among employees who have received treatment for substance use disorders.²³ Health problems following treatment also improve, with alcohol- and drug-related medical visits declining 53 percent.²⁴

Research has consistently found that people who have untreated substance use disorders typically have high rates of repeated contacts with the justice system and a greater chance of re-incarceration. However, when inmates receive treatment for a substance use disorder, re-arrests have shown to drop from 75 percent to 27 percent. ²⁵

The Cost of Substance Use Disorders

To foster a greater understanding that substance use disorders are treatable and to enable the people who need it to have access to affordable and convenient options, there is a need to increase awareness of the impact that substance use disorders have on our communities. A lack of treatment for people with substance use disorders continues to impact millions of people, some of whom may work and live right beside you. In 2005:

• Most binge and heavy alcohol users^* were employed. Among the 52.6 million adult binge and heavy alcohol users, 42.1 million (or 80 percent) were employed either full or part time.²⁶
• Of the 17.2 million illicit drug users aged 18 or older, 12.9 million (74.8 percent) were employed either full or part time.²⁷

Despite the positive outcomes stemming from the treatment of substance use disorders, treatment costs continue to hinder access for many of those in need. Combined data from 2004 and 2005 state that among people who needed treatment for a substance use disorder, didnt receive it at a specialty facility, and felt they needed it, 35 percent said they did not receive it because of cost and insurance barriers.²⁸

Substance use disorders can take an enormous toll on individuals, as well as on families and the entire community. Dependence on alcohol and/or drugs can impact an individuals self-esteem, cause an inability to sustain meaningful relationships, serve as an obstacle to professional success, and increase personal health costs. Perhaps the most detrimental is the negative impact substance use disorders have on a persons self worth and on relationships with his or her family and community. For example, people in the recovery community list embarrassment or shame as the second most often cited obstacle to recovery. ²⁹

Families with parents who have an alcohol and/or drug dependence experience a multitude of other social problems, including a higher risk of having children who misuse alcohol and/or drugs themselves. Children from these families are also more likely to have problems with delinquency, school performance, and emotional development, such as aggressive behavior and hyperactivity. ³⁰

Financially, substance use disorders can have negative effects on larger institutions, including lost productivity and absences in the workforce, as well as increasing health care costs for other illnesses directly related to dependence or abuse. For alcohol alone, the total economic costs in 1998 were estimated to be $184.6 billion, which includes the cost of medical consequences, lost earnings linked to premature death, lost productivity, motor vehicle crashes, crime, and other social consequences.^31,32 For drug use disorders, the economic costs in 2002 were estimated at $180.9 billion, demonstrating a 5.3-percent increase in average costs per year from 1992 through 2002. This value includes the use of resources to address health and crime consequences and the loss of potential productivity from disability, death, and withdrawal from the workforce.³³ The following chart illustrates the amount spent on treatment and the economic costs of substance use disorders:^34,35,36,37

The largest component of the cost of substance use disorders is the loss of productivity^* and its impact on businesses. In 2002, drug use disorders alone contributed to a loss of productivity amounting to $128.6 billion.³⁸ Alcohol dependence is estimated to cause 500 million lost workdays annually.³⁹

Health care costs increase for people with substance use disorders and contribute to our nations ongoing struggle with rising costs in the health care system. Health-related costs in 2002 were projected to total $16 billion for drug use, representing an increase of $5.1 billion since 1992.⁴⁰ Problem drinkers average four times as many days in the hospital as nondrinkers, mostly due to drinking-related injuries. Moreover, there are substantial health care costs for people who do not have substance use disorders, but are harmed by the behavior of those who are dependent on alcohol and/or drugs, such as motor vehicle accidents.⁴¹

Saving Lives, Saving Dollars

Whether you are a policymaker, health care provider, business leader, or a community member, you have an opportunity to spread the word about the extraordinary benefits to the entire country that can result from investing in treatment for people with substance use disorders. The following are a few resources and tools to help you convey the cost effectiveness of treatment and recovery.

To address affordability issues, as well as other barriers to treatment, President Bushs Access to Recovery (ATR) program, administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), is working to increase each persons access to treatment. This grant program gives recipient states, territories, the District of Columbia, and tribal organizations broad discretion to design and execute federally supported voucher programs to pay for a wide range of effective, community-based substance use disorder clinical treatment and recovery support services.

In many areas, the justice system improves peoples access to treatment through drug courts. Drug courts represent the coordinated efforts of the judiciary, prosecution, defense bar, probation, law enforcement, mental health, social service, and treatment communities to actively intervene and break the cycle of dependence on alcohol and/or drugs.⁴² There are more than 1,600 planned or existing drug courts in the United States that provide job/skill training, family and group counseling, and other resources that help individuals and their families cope.^43,44

More people can have a positive impact on the community as they spread the encouraging message that treatment works and recovery is possible. Supporting those who are affected by substance use disorders will not only foster a more productive community, but also will save the lives of countless people who may otherwise have been lost.

For more resources and organizations that can help provide treatment, visit the Recovery Month Web site at www.recoverymonth.gov. For additional Recovery Month materials, visit www.recoverymonth.gov or call 1-800-662-HELP.

Glossary

Much has been written about substance abuse, dependence, and addiction; many studies have used different terminology to explain their findings. To foster a greater understanding and avoid perpetuating any stigma associated with these conditions, the phrase "substance use disorders" is used as an umbrella term to encompass these concepts.

Below you will find extensive definitions of substance use disorders, as well as other terms that appear highlighted throughout this document. Unless otherwise noted, more detailed definitions and criteria can be found in the 2005 National Survey on Drug Use and Health: National Findings at www.oas.samhsa.gov/nsduh.htm.

Substance use disorders - Substance use disorders involve the dependence on or abuse of alcohol and/or drugs. Dependence on and abuse of alcohol and illicit drugs, which include the nonmedical use of prescription drugs, are defined using the American Psychiatric Associations criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4^th edition (DSM-IV). Dependence indicates a more severe substance problem than abuse; individuals are classified with abuse of a certain substance only if they are not dependent on it.⁴⁵

Treatment - Treatment is a path of recovery that can involve many interventions and attempts at abstinence. It is offered in different settings, and types of treatment greatly depend on the substances misused, as well as a persons individual needs and characteristics. Treatment is offered in residential and outpatient programs and can include counseling or other behavioral therapy, family therapy, medication, or a combination of services.^46,47,48 For more information, please refer to "A Guide To Treatment: Methods To Help People With Substance Use Disorders" in this planning toolkit.

Recovery - Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life. Individuals from the recovery community and treatment-related service providers developed this definition through the National Summit on Recovery process sponsored by the Substance Abuse and Mental Health Services Administrations (SAMHSAs) Center for Substance Abuse Treatment (CSAT).

Binge use - Binge use of alcohol is defined as drinking 5 or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days.⁴⁹

Heavy use - Heavy use of alcohol is defined as drinking 5 or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on 5 or more days in the past 30 days. Heavy alcohol users also are considered binge users of alcohol.⁵⁰

Drink - For the purposes of some of the research provided in this document, a drink is considered a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it.⁵¹

Loss of productivity - This is a loss that represents work in the labor market and household production that was never performed, but could reasonably be expected to be performed if it were not for drug misuse.⁵²

Serious psychological distress/mental health problems - These problems occur in people who exhibit a high level of distress due to any type of mental problem, which may include general symptoms related to phobia, anxiety, or depression.⁵³ A national organization, Mental Health America, provides greater detail about the types of mental health problems that correlate with substance use disorders. Mental health problems often predate substance use disorders by 4 to 6 years; alcohol and/or drugs may be used as a form of self-medication to alleviate the symptoms of a mental disorder.

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