Content area
Full Text
Broad public health policies and practices are making slow but sure progress toward improving the health of particular groups of Americans through insurance coverage, screening, and treatment of certain diseases. Meanwhile, prevention and treatment of substance use has gotten the short shrift at a high price.
Failure to provide accessible and effective substance abuse treatment costs US taxpayers up to $276 billion per year.1 Included in these costs are expenditures for medical care, law enforcement, motor vehicle accidents, lost productivity, and incarceration; not included are the consequent foster care and social service costs for children whose parents fail to receive needed substance abuse treatment. Approximately 55% of the economic burden of alcohol and drug problems is borne by those who do not use these substances.1 Commenting on the significant increases since 1985 in the costs of drug addiction, Alan Leshner, the director of the National Institute on Drug Abuse, notes that the "emergence of health problems from the cocaine and HIV epidemics during this period substantially increased drug-related costs to society."2
Drug Use and Addiction
The future costs to US society of substance use and addiction will depend in great part on the trend of chronic drug use as well as the initiation of use among youth. Indicators of chronic drug use (e.g., mortality, emergency room admissions, drug treatment admissions, and arrest urinalysis data) show that crack cocaine and heroin use are the predominant sources of illicit drug problems.3 While indicators of chronic use suggest a leveling off in crack use, heroin use continues to increase.3 Chronic methamphetamine use is also increasing in many parts of the country.3
The Monitoring the Future Survey on substance use and attitudes toward substance use among young people produced both good and bad news. Despite decreasing trends in the use of some drugs among youths (e.g., marijuana, alcohol, and cigarettes among 8th graders) and a leveling off in drug use among some groups (e.g., most illicit drugs among 12th graders), substance use remains stubbornly common among adolescents and young adults.4 Approximately 41.4% of 12th graders, 35% of 10th graders, and 21% of 8th graders reported using an illicit drug in the last year.4 The bad news is also echoed in the findings of the National Household Survey, which reported...