Substance abuse and addiction has changed everyday life in urban America--the way we live and die, play and pray, learn and work--according to a groundbreaking two and one-half year study released last Wednesday by the Center on Addiction and Substance Abuse at Columbia (CASA) titled "Substance Abuse and Urban America: Its Impact on An American City, New York."
The 230-page report, the first of its kind, found that substance abuse cost $20 billion in New York City in 1994, and that 21 cents of every dollar New Yorkers pay in city taxes is due to tobacco, alcohol and drug abuse.
CASA used New York City as a laboratory for urban America because of its size and because the social and economic problems there exist in every large city in the nation.
"The study shows that substance abuse and addiction lurks behind the problems of urban America--crime and violence, health care costs and crowded emergency rooms, child and spouse abuse, homelessness and AIDS, welfare and foster care, and high taxes and business costs. To solve these problems, we must deal with tobacco, alcohol and drug abuse," said Joseph A. Califano Jr., CASA President and former Secretary of Health, Education, and Welfare.
Califano released the report at a press conference at the St. Regis Hotel in New York City. He was joined by two National Institutes of Health officials, Alan I. Leshner, director of the National Institute on Drug Abuse, and Enoch Gordis, director of the National Institute on Alcohol Abuse and Alcoholism.
"The findings from this unprecedented CASA study clearly show that any effective strategy to deal with the problems of urban America must include a major focus on substance abuse and addiction," said Leshner. "And they reaffirm that drug abuse is not only a social issue, but also a health problem that dramatically affects both the health of the individual and the health of the public."
Gordis congratulated CASA for "its important analysis." He said, "The CASA report is striking in two ways: by focusing on a single city, analysis can be pursued with a level of detail not possible in a national study. Furthermore, especially for those who have lived in New York, the local numbers take on a frightening immediacy because of that detail. Yet again, the report indicates that the costs of alcohol abuse and alcoholism far exceed the costs of all other drug abuse."
The study reveals the enormous opportunity and rewards for any city that mounts an all-fronts assault on substance abuse. If in New York City, tobacco, alcohol and drug abuse were reduced by just 20 percent, then each year: $520 million in inpatient hospital costs would be saved; 670 fewer New Yorkers would die of AIDS; 400,000 days of hospital care and 1,100 hospital beds could be eliminated; and 1,800 nursing home beds could be opened up. There would be 7,600 fewer reports of substance abuse-related child abuse, a drop in teen pregnancy and in the number of families on welfare, and an increase in the number of teenagers completing high school. A 20 percent cut in drug- and alcohol-related crime would mean a reduction of 63,000 in the number of reported drug- and alcohol-related felonies.
"Reducing substance abuse and addiction will give citizens across urban America the opportunity to cut taxes and commit resources to other public purposes," he said.
The $20 billion in substance abuse-related costs to the public and private sectors in New York City, nine percent of the $225 billion Gross City Product, is an underestimate, because of unreported crime, inadequate health records, inability to quantify most costs to education, reliance on self-reported surveys and other reasons detailed in the report.
"If the CASA study had captured all of these costs," Califano said, "the impact would be 10 to 15 percent higher, or $22 billion to $23 billion."
Of the $20 billion, some four percent went to treat ($735 million) and prevent ($80 million) substance abuse and addiction; the remaining 96 percent ($19.2 billion) was spent to deal with its deadly consequences. The costs break down this way:
Of the $20 billion, the federal government paid $3.9 billion through such programs as Medicare and Aid to Families with Dependent Children (AFDC), the state paid $2.5 billion and the city paid $3.8 billion.
The remaining amount is the cost to the private sector and the economy as a whole. The city's $3.8 billion share equals 21 percent of the $18 billion in taxes it collects.
In New York City, there are some 1.3 million people hooked on tobacco, 540,000 alcoholics and problem drinkers and 490,000 illicit drug abusers. One in five New Yorkers age 18 or older (more than 1.1 million adults) binge drinks every week; 20 percent of 7th to 12th graders, 100,000 junior high and high schoolers, smoke, and 50,000 binge drink at least weekly.
"Every urban resident has a friend or relative who is a substance abuser and most know someone who died as a result," Califano said. "Violence related to drugs may dominate local television news, but far more urban Americans die from diseases resulting from tobacco (lung cancer, emphysema and coronary artery disease), alcohol (hypertension, cirrhosis and breast cancer) and illegal drugs (AIDS, cerebrovascular disease)."
In New York City, one of every five deaths is due to an alcohol-, drug-, or tobacco-related condition. As might be expected, substance abuse and addiction hits hardest in a city's poorest sections, but it can be found in all urban neighborhoods.
Substance abuse and addiction is particularly savage with respect to children. In 1994 in New York City, because of substance abuse and addiction:
By the sixth grade, most children in urban America have seen individuals use illegal drugs. Any can find their learning disrupted by the alcohol- and drug-related behavior problems of other students. In a New York City junior high or high school class of 30 students, an average of five use marijuana and/or other illicit drugs heavily. Among 15- to 24-year-olds, substance abuse, in the form of AIDS, homicides and drug and alcohol overdoses, accounts for 64 percent of deaths.
Columbia University Record -- March 8, 1996 -- Vol. 21, No. 19