Substance Abuse Top Health Problem

WASHINGTON - Substance abuse is the nation's top health problem, causing more deaths, illness and disabilities than any other preventable health problem today, according to a major report to be issued today.

Of the more than 2 million deaths each year in the United States, about one in four is due to abuse of alcohol, tobacco or illicit drugs, the report says. The economic cost of the abuse is estimated at more than $414 billion a year.

"This is an enormous burden that affects all of society - people who abuse alcohol, tobacco and illicit drugs, and those who do not," says the report prepared for the Robert Wood Johnson Foundation, the nation's largest health care philanthropy.

No population group is immune to substance abuse and its effects, the report says. Men and women, and people of all ages and ethnic groups drink, smoke and use illicit drugs, and the negative effects often spread far beyond the users themselves.

Tobacco, alcohol and other drug use are down from earlier peaks. But, said Constance Horgan, a Brandeis University researcher and the report's chief investigator, "Our conclusion overall is that society continues to pay the price for a problem that is largely preventable and treatable."

The report, which exceeds 110 pages, is consistent with other research and is believed to be the most comprehensive single- volume examination of the problems of substance abuse. It makes these points, among others:

Tobacco use causes 430,700 deaths a year and creates $138 billion in annual costs. Cigarette use continues to decline, with consumption in 2000 the lowest since 1963. Cigar use has increased recently. Every year, more than 5 million years of life could have been saved if every person who died from cigarette smoking had lived to his or her average life expectancy.

Use of alcohol causes an estimated 100,000 deaths a year and $166.5 billion in annual economic costs. While the use of alcohol has declined, it remains the most commonly used drug among young people and widespread binge drinking among college students is one of the most serious public health problems on college campuses today.

Illicit drug use causes nearly 16,000 deaths a year and causes about $110 billion in annual economic costs. Use of marijuana has declined from recent peak levels, but there has been a sharp increase in the use of Ecstasy among teenagers.

The effects of substance abuse spread to virtually every corner of modern society, the report says.

Exposure to second-hand smoke, for example, is "an acknowledged health hazard" that each year causes 3,000 lung-cancer deaths among nonsmokers, the report says. In addition, more than 6,000 deaths among children each year are linked to parental smoking, primarily from low birth weights caused by smoking during pregnancy.

Moderate use of alcohol may have some health benefits, the report says, but heavy drinking contributes to illness in each of the three top causes of death: heart disease, cancer and stroke.

Drug-related deaths have more than doubled since the early 1980s, the report says, and often involve a lethal mix of illicit drugs and alcohol. Deaths directly related to drugs "grossly underestimate" the mortality toll from illicit drugs, the report says, because they exclude deaths linked to diseases such as AIDS.

Treatment for substance abuse works, the report says, but is often not available. Fewer than 25 percent of those who need treatment for abuse of alcohol or illicit drugs were found to receive it.

Part of the problem is attributed to a lack of resources. Spending on the criminal justice system and interdiction consumes up to 60 percent of the federal drug-control budget, while only 18 percent is devoted to treatment, the report states.

Still, recent studies show that treatment for alcoholism is 40 percent to 70 percent successful and treatment for cocaine use is 50 percent to 60 percent successful.

"Perhaps we haven't been asking ourselves the right questions about treatment," said Horgan. "The improvement rate for people completing substance abuse treatment is comparable to that of people treated for asthma and other chronic, elapsing health conditions. Treatment is a wise public investment."

Laurel Wood, program manager for inpatient psychiatry at St. Francis Care Behavioral Health in Portland and Hartford, said the health care system itself can be a barrier to substance abuse treatment. For example, she said, many HMOs prefer to begin with the least expensive treatment. But some patients are poor prospects for outpatient treatment because there is substance abuse at home or in the neighborhood. Even a few days in a residential program could help, she said. "The recovery environment is crucial."

While much of today's report looks at substance abuse and its effects, the massive document also includes a section on the role of the media in shaping popular perceptions of the risks involved in using alcohol, tobacco and illicit drugs.

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