Government spending related to smoking and the abuse of alcohol and illegal drugs reached $468 billion in 2005, accounting for more than one-tenth of combined federal, state and local expenditures for all purposes, according to a new study.
Most abuse-related spending went toward direct health care costs for lung disease, cirrhosis and overdoses, for example, or for law enforcement expenses including incarceration, according to the report released Thursday by the National Center on Addiction and Substance Abuse, a private group at Columbia University. Just over 2 percent of the total went to prevention, treatment and addiction research. The study is the first to calculate abuse-related spending by all three levels of government.
"This is such a stunning misallocation of resources," said Joseph A. Califano Jr., chairman of the center, referring to the lack of preventive measures. "It's a commentary on the stigma attached to addictions and the failure of governments to make investments in the short run that would pay enormous dividends to taxpayers over time."
Beyond resulting in poor health and crime, addictions and substance abuse — especially alcohol — are major underlying factors in other costly social problems like homelessness, domestic violence and child abuse.
Shifting money from hospitals and prisons to addiction treatment and research has never been politically easy, and it is all the harder now because the federal government and most states face large budget deficits and are cutting many key services. But Califano said that many preventive measures had rapid payoffs in medical and other expenses.
The work of the center and of Califano, who was a secretary of health, education and welfare in the 1970s, have sometimes drawn fire from conservatives who put more emphasis on law enforcement than drug treatment and, on the other side, from groups who advocate loosening some drug laws and using needle exchanges and supervised addiction maintenance, as some European countries do, to reduce the personal and societal costs.
Ethan Nadelmann, director of the Drug Policy Alliance, a national group advocating legal reforms, said it was misleading for the report to lump together direct costs of tobacco, alcohol and drug abuse, like ill health, with expenses relating to enforcement of marijuana laws and prison. Many of the criminal justice costs, Nadelmann said, are not an inherent result of drug use but rather of policy choices to criminalize it.
By Erik Eckholm
May 27, 2009