The National Center for Addiction and Substance Abuse (CASA) just released a startling study showing that states are spending thirteen percent of their budgets, on average, to deal with substance abuse. Vermont spends 11.9% of our budget – $221.42 per capita – on substance abuse. This figure does not include additional federal dollars that are transferred to Vermont in the form of Medicare, Medicaid and other programs to help mitigate the effects of substance abuse. It also does not include local substance abuse costs, particularly law enforcement costs, borne by our cities and counties.
The images that may come to mind of substance abuse for many are those of teenagers smoking marijuana out behind the school, or crack addicts buying drugs in a dark hallway of a rundown apartment building. This is certainly the image that is promoted by the media and even at times by our government. But the reality is that alcohol – one of this country’s most widely advertised and readily available products – is the source of most substance abuse in this country. It is also the source of most substance abuse costs.
According to the CASA report, of the $81.3 billion spent by states on substance abuse, at least $9.2 billion is spent on alcohol alone. This is compared with costs of $7.4 billion for tobacco alone and $1.1 billion for illicit drug use alone. CASA also estimates that the majority of the remaining $63.6 billion is linked to alcohol abuse that is combined with some other drug abuse.
Despite the enormous costs, both personal and financial, of alcohol abuse, we as a nation continue to treat drinking, even high-risk drinking, with a wink and a nod. Alcohol products, particularly beer, continue to be promoted extensively in ways that reach our youth. The Federal Trade Commission reports that over $1 billion per year is spent on “measured” alcohol advertising, including TV, radio, magazines and billboards; it is estimated that the alcohol industry spends an additional $3 billion on event sponsorships, clothing and other brand paraphernalia, and promotions. One result of this overexposure to alcohol is a decreased perception among young people of the consequences of alcohol abuse. The percentage of youths believing that having five or more drinks once or twice a week is risky behavior has decreased from 54.3 percent in 1994 to 42.2 percent in 1999. More needs to be done to reduce our young people’s exposure to alcohol industry messages.
We also need to come up with stronger state and local policies that make it easier for youth to make good decisions. Here in Vermont, we continue to allow those under 21 into bars. Our ability to deal locally with problem alcohol outlets is hampered by state regulations. We need more effective and frequent training for bar owners and servers in responsible beverage service practice. And we must eliminate promotions and drink specials that encourage binge drinking. Adults who profit from high risk drinking need to be made responsible for their actions; they also need to begin to help bear the costs of alcohol abuse in our society.
Joseph Califano, the president of CASA, points to the tiny percentage of substance abuse dollars going to treatment and prevention – about four percent of the total – as being a major problem. The White House Office of National Drug Control Policy said the report demonstrated the need for a “balanced strategy.” While certainly an increased emphasis on treatment and prevention is needed, this is only a part of the answer. We need to take seriously our need to change the environment and culture around alcohol.
CASA’s report was entitled “Shoveling Up: the Impact of Substance Abuse on State Budgets.” A more accurate title would have been “Mopping Up,” considering the lion’s share of costs are related to alcohol abuse. We need to turn off the tap, by changing the culture around alcohol and thereby reducing the number of people, particularly youth, engaged in high-risk drinking behavior. Then we won’t be doing as much of the more expensive, and painful, mopping up of alcohol-related problems in the future.