09 March 2001

Text: New Report Calls Substance Abuse
Number-One Health Problem in U.S.

A comprehensive report on substance abuse in the United States reveals that smoking, drinking and illicit drug use cause "more deaths, illnesses, and disabilities than any other preventable health problem today," says the Robert Wood Johnson Foundation.

The foundation, which commissioned the report (entitled "Substance Abuse: The Nation's Number-One Health Problem"), described its findings in a March 9 press release. "Today's report contains data from several hundred public and private sources, ... [examining] long-term trends over the previous three decades in patterns of substance abuse, consequences to society, and approaches for combatting the problem," the foundation said. It added that, according to the report, treatment for addicts is in the United States is "severely underutilized," despite the fact that "the economic cost of substance abuse is staggering, estimated at more than $414 billion [$414,000 million] in 1995."

The report also concluded that early use of alcohol, tobacco or illicit drugs is often a strong risk factor for addiction. Substance abuse by young people under age 20, and particularly by those under age 15, increases the likelihood of substance abuse problems later in life, the report said.

While the report characterized addiction as "a chronic, relapsing health condition" that often requires prolonged and repeated treatment, it nevertheless advocated treatment, citing benefits including reduced crime rates and enhanced productivity. Overall, "treatment -- even with multiple treatment episodes -- is less expensive than the alternatives of incarceration and untreated addiction," the foundation said in its summary of the report.

Hard copies of the report may be ordered by visiting the foundation's web site at: www.rwjfliterature.org/chartbook/chartbook.htm.

Following is the text of the March 9 press release:

{Note: In the text, "billion" equals "thousand million."]

For further information, contact:
Ellen Wilson or Dionne Dougall at
Burness Communications: 301-652-1558

Comprehensive Report Illustrates How Substance Abuse Plagues Nation As Number-one Health Problem In Deaths, Illnesses, And Disabilities

Report Tracks Smoking, Drinking, Illicit Drug Use over Several Decades; Documents Early Use Among Young People

WASHINGTON, D.C. (March 9, 200l) -- A new report released today finds that young people are experimenting with drugs, alcohol, and tobacco at early ages. The report also finds that illicit drug and tobacco use increased dramatically among youth through the mid-1990s. But since then, these trends in use have shifted downward, although the new drug, ecstacy, is on the rise.

The comprehensive report, commissioned by The Robert Wood Johnson Foundation and prepared by the Schneider Institute for Health Policy at Brandeis University, tracks positive and negative trends in smoking, drinking, and illicit drug use over several decades. The report substantiates its title, "Substance Abuse: The Nation's Number One Health Problem," by documenting that substance abuse causes more deaths, illnesses, and disabilities than any other preventable health problem today. The report can be found under "Substance Abuse Chartbook" at http://substanceabuse.rwjf.org -- the new Substance Abuse Resource Center of The Robert Wood Johnson Foundation web site designed for community leaders, researchers, and professionals who deal with substance abuse issues.

Today's report contains data from several hundred public and private sources, reporting snapshots and long-term trends over the previous three decades in patterns of substance use, consequences to society, and approaches for combatting the problem.

Among other findings, the report discusses the role that the media have played in influencing teens' substance use and looks at how treatment, though shown to be effective by numerous scientific studies, is severely underutilized.

It also reports that the economic cost of substance abuse is staggering, estimated at more than $414 billion in 1995. Of the more than two million deaths each year in the U.S., one in four is attributable to alcohol, tobacco, and illicit drug use. In 1995, health care spending associated with alcohol, tobacco, and drug abuse was estimated at more than $114 billion.

"This report demonstrates that there is a gap between what we know about prevention and treatment, and what we actually do to prevent and treat this enormous problem," said J. Michael McGinnis, M.D., senior vice president and director of the Health Group at The Robert Wood Johnson Foundation, the nation's largest health and health care philanthropy.

"This report provides a complete picture of substance use, abuse, and dependence over a span of years," said Connie Horgan, principal investigator at Brandeis University. "Our conclusion overall is that society continues to pay the price for a problem that is largely preventable and treatable."

Implications of Early Use

By the 8th grade, 52 percent of adolescents have consumed alcohol, 41 percent have smoked cigarettes, and 20 percent have used marijuana. According to the report, young people account for the majority of increases in the numbers of new initiates for many substances. The rising prevalence of marijuana use during the first half of the 1990s was driven, in large part, by the increasing rates of new use among youths aged 12 to 17. Declines in the mean age of first use of cocaine and heroin were accompanied by an upward trend in the rates of new cocaine and heroin users among the 12- to 17-year-old age group.

"The younger use begins, the more likely the users are to have substance abuse problems later in life, especially if use begins before age 15," said Horgan. "Just when they are beginning to assume more mature responsibilities in society, young adults aged 18 to 34 are more likely than any other age group to drink heavily, smoke cigarettes, and use illicit drugs."

More than 40 percent of those who started drinking at age 14 or younger developed alcohol dependence, compared with 10 percent of those who began drinking at age 20 or older. High school students who use illicit drugs are also more likely to experience difficulties in school, in their personal relationships, and in their mental and physical health.

A critical aspect of substance use is the perception of risk. Young people may use substances at an early age because of their perception that many of these substances will not harm them. "The relationship between perception of risk and use of substances is particularly important for young people who generally believe there is less risk in using substances than their older counterparts," said Horgan.

Media Depictions of Substance Use

The media play a critical role in shaping the perception of risk. Increases in substance use among youth between the early 1990s and 1996 were linked to decreases in the perception of potential harm from using many substances, particularly marijuana. This period also saw a decline in the prevalence of warning and anti-drug messages from the media, parents, and schools; the proliferation of pro-use messages from the entertainment world; and high levels of tobacco and alcohol product advertising and promotion.

According to the report, movies and popular songs -- media forms particularly favored by teenagers frequently depict the use of alcohol, tobacco, and illicit drugs. In the 200 most popular movie rentals in 1996 and 1997, alcohol appeared in 93 percent and tobacco in 89 percent of the movies. Illicit drugs appeared in 22 percent of movie rentals in 1996 and 1997, with marijuana and cocaine depicted most often. Findings from an analysis of the 1,000 most popular songs in 1996 and 1997 revealed that 27 percent of the songs referred to either alcohol or illicit drugs.

"For parents, it must seem that everywhere they turn, there's a movie, song, music video, or television ad that showcases the use of substances," said Horgan. "With this kind of competition from popular culture and mass media, it's even more of a challenge for parents to show their children that the dangers of substance use are very real."

In 1999, 44 percent of non-news programs aired by the four major television networks portrayed tobacco use in at least one episode. In 1998, the tobacco industry spent $6.7 billion for advertising and product promotions, and the alcohol industry spent more than $1 billion on television, radio, print, and outdoor advertising in 1997.

Proven Treatment Options Underutilized

More than 18 million people who use alcohol and almost five million who use illicit drugs need treatment. Fewer than one-fourth of those in need get treatment. On the federal level, spending on the criminal justice system and interdiction takes up 60 percent of the federal drug control budget, while only 18 percent is devoted to treatment.

A major question asked about drug and alcohol abuse treatment is, "Does it work?" The report documents that it does. Recent studies show that after six months, treatment for alcoholism is successful for 40 to 70 percent of patients, cocaine treatment is successful for 50 to 60 percent and opiate treatment for 50 to 80 percent, with effectiveness defined as a 50 percent reduction in substance use after six months.

According to the report, addiction is a chronic, relapsing health condition. Substance abusers may, therefore, be in treatment multiple times -- or make repeated attempts to quit on their own -- before they are successful.

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

Overall, according to the report, treatment -- even with multiple treatment episodes -- is less expensive than the alternatives of incarceration and untreated addiction. The benefits of treatment include reduced crime, enhanced productivity, and lower health care use. Yet it is surprising that many newer treatment options are not being used. For example, naltrexone -- a medication used to treat dependence on drugs like heroin -- was approved in 1994 to treat alcohol dependence, as well, but is not widely prescribed.

Similarly, many current smokers want to quit, but treatment is underutilized, despite recent pharmacological advances in treating tobacco addiction, such as the nicotine patch. Health plans typically do not cover cessation services, and relatively few doctors provide even brief counseling. Yet physician advice has been shown to increase long-term abstinence rates by 30 percent.

Other Trends and Findings from the Report

• Substance Abuse and Violence: At least half of adults arrested for major crimes -- including homicide, theft, and assault -- tested positive for drugs at the time of their arrest. Among those convicted of violent crimes, approximately half of state prison inmates and 40 percent of federal prisoners had been drinking or using drugs at the time of their offense. Alcohol is more likely to be involved in crimes against people than property. Up to 60 percent of sexual offenders were drinking at the time of their offense. More than 75 percent of female victims of non-fatal domestic violence report that their assailant had been drinking or using drugs.

• Education, Income, and Substance Abuse: People with more education are more likely to drink, but those with less education are more likely to drink heavily. Rates of heavy alcohol use are highest among those with less than a college degree. Among people with less education, smoking is more common, and smoking cessation less likely. In addition, heavy smoking is higher among those without a high school diploma. Similarly, current illicit drug use is twice as high among those aged 26 to 34 who have not completed high school than among those in the same age group with a college degree. Use of multiple drugs, including alcohol and tobacco, is common among substance abusers, particularly among the economically disadvantaged.

• Gender Differences in Substance Abuse: Gender differences are most apparent among heavy users. Males are almost four times as likely as females to be heavy drinkers, nearly one and a half times as likely to smoke a pack or more of cigarettes a day, and twice as likely to smoke marijuana weekly.

• Regulation on Smoking and Alcohol Use: In the past decade, tax increases and regulatory strategies have been an increasing focus of efforts to further reduce alcohol and tobacco use. It is estimated that a 50 percent increase in cigarette prices would result in a 12.5 percent reduction in the number of smokers, or 3.5 million fewer smokers nationwide. Although some states have raised excise taxes, the U.S. cigarette tax remains among the lowest in the developed world. Clean indoor air laws and legislation lowering the legal drunk driving limits for adults and youth are increasingly popular ways of reducing tobacco and alcohol use.

• Costs of Substance Abuse: The economic cost of substance abuse to the U.S. is staggering. Alcohol abuse is the most costly at $166.5 billion, followed by smoking at $138 billion and drug abuse at nearly $110 billion. The major burden of alcohol abuse is related to productivity losses associated with illness and death; for smoking, the most significant losses are associated with health care costs for myriad adverse health effects and productivity losses due to premature deaths; and for drug-related costs, crime plays the major role.

To order hard copies of Substance Abuse: The Nation's Number One Health Problem, please either write to The Robert Wood Johnson Foundation; Attn: Substance Abuse Chartbook, Route 1 and College Road East, P.O. Box 2316, Princeton, NJ 08543-2316, or visit www.rwjfliterature.org/chartbook/chartbook.htm.

The Robert Wood Johnson Foundation, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care. It concentrates its grantmaking in three goal areas: to assure that all Americans have access to basic health care at reasonable cost; to improve care and support for people with chronic health conditions; and to reduce the personal, social, and economic harm caused by substance abuse -- tobacco, alcohol, and illicit drugs. For more information, check the web site at www.rwjf.org.

The Schneider Institute for Health Policy (SIHP) located in the Heller School at Brandeis University has achieved national recognition as a leading health care policy and research institution. SIHP examines health and the health care system from a variety of perspectives including questions of access to and quality of care, how health care is financed, delivered, and utilized, and the cost of such care. In many of its studies, SIHP focuses on the special problems of our most vulnerable populations, including the elderly, individuals with chronic illness, those with substance abuse problems, and mental illness. For more information check the SIHP web site at: http://sihp.brandeis.edu

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