Substance Abuse Prevention Can’t Be an Afterthought in Health Care Reform
By Jerry Jaker, Ed.S.
Years ago, as director of the state-funded Minnesota Prevention Resource Center, I was regularly invited to present the final segment on the last day of the Johnson Institute’s intensive 10-day Chemical Dependency and the Family training program. Although fatigued from information overload, participants from all over the world sat dutifully, luggage under their chairs, airplane tickets in hand, as I talked about the importance of substance abuse prevention. My job was to make a topic that is often either overlooked or treated as an afterthought in conversations about health care seem compelling.
Some things haven’t changed since those days. Substance abuse prevention often still gets the short shrift in discussions about health care, and that is the case in our current debate about national health care reform. However, much has changed in the prevention realm since I used to give those concluding talks. The research on substance abuse prevention has grown, and it is now an evidence-based discipline. Interventions are valued not because of how popular or well-marketed they are but because they have been proven to work. Model programs and practices have been developed, piloted, evaluated, peer-reviewed, adapted, and taken to scale. The federal government’s Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices lists the best ones. Those practices have moved from being promising exceptions to the new normal. Project Northland and Communities Mobilizing for Change on Alcohol are two interventions on the registry that were created in Minnesota.
The research on prevention has shown not only which interventions work but also that prevention is cost-effective. For example:
- Studies have shown that alcohol use is a major risk factor for cardiovascular disease, liver disease, and some cancers. According to the Minnesota Department of Health, it is the primary cause of almost 1,400 deaths per year in our state.1
- Studies coming out of the Partnerships in Prevention Science Institute at Iowa State University indicate that substance abuse prevention leads to increased productivity and tax revenues, lower health care costs, reduced burden on the criminal justice system, decreased welfare reliance, and more.2
- Evidence shows effective substance abuse prevention more than pays for itself, especially when proven programs and initiatives are properly implemented.3
- Prevention initiatives targeted at young children have been shown to delay or prevent substance abuse later on. For example, kids who are younger than 14 years of age when they first smoke pot are more than five times as likely as those who first try marijuana after age 18 to abuse drugs as adults, according to the National Household Survey on Drug Use findings.4 That’s serious problem reduction and prevention.
In short, when you consider the savings, value, and contribution to better health and improved quality of life that substance abuse prevention offers, its value quickly becomes clear. For that reason, substance abuse prevention deserves to be at the center of the health care reform dialogue and not tacked on at the end of the debate. There needs to be informed discussion about effective prevention and wellness services including abuse prevention that employers will consider paying for and that health improvement leaders can offer.
We need to keep the efficacy of the best practices in substance abuse prevention on the radar screens of the policymakers and stakeholders leading the health reform dialogue. We need to work to make sure the words “investment in prevention” are backed with real dollars for real programs. The health impact of substance abuse is huge. Do you know anybody whose life hasn’t been affected by the consequences of someone’s substance abuse? I don’t. Prevention should be anything but an afterthought. MM
Jerry Jaker is the executive director of the Minnesota Institute of Public Health.
References
1. Minnesota Department of Health. The Human and Economic Cost of Alcohol Use in Minnesota. 2006. Available at: www.health.state.mn.us/alcohol/alcpdf/final2004costfactsheet.pdf. Accessed December 8, 2009.
2. Iowa State University. Partnerships in Prevention Science Institute. Available at: www.ppsi.iastate.edu/. Accessed November 9, 2009.
3. Miller T, Hendrie D. Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis, DHHS Pub. No. (MA) 07-4298. Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, 2009. Available at: http://download.ncadi.samhsa.gov/prevline/pdfs/SMA07-4298.pdf. Accessed December 8, 2009.
4. Substance Abuse and Mental Health Services Administration. Results from the 2008 National Survey on Drug Use and Health: National Findings, NSDUH Series H-36m HHS Publication No. SMA 09-4434. Rockville, MD: U.S. Department of Health and Human Services SAMHSA Office of Applied Studies, 2009.