Drug Treatment - How Much Does The Nation Spend Ondrug Treatment?

The federal government expends substantial sums yearly obtaining data on how many people use drugs, how many are admitted to treatment facilities, how many treatment centers exist, how many hectares of opium poppy or coca bushes are eradicated, how many persons are arrested on drug charges, and on obtaining other similar measurements of progress. Current data on expenditures on treatment or the cost of treatment across the nation, how-ever, are not available. In its 2002 report to Congress (Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Disorders, SAMHSA, 2002, http://alt.samhsa.gov/reports/congress2002/) SAMHSA stated that the most recent data on national expenditures for substance abuse were from 1997. That year, according to the agency, $11.4 billion was spent on substance abuse by government bodies at all levels and by the private sector. In that year the federal budget for drug treatment was $2.6 billion, or about 23% of the total spent. By 2004 the federal budget for drug treatment had risen to $3.4 billion, according to SAMHSA. Increases between 1997 and 2004 were in part due to higher than average inflation in the medical care services component of the Consumer Price Index (CPI).

Federal Expenditures

In fiscal year (FY) 2004 (which ended September 30), the federal government had authority to spend $12.1 billion on all aspects of drug control. Of this total, $3.4 billion was earmarked for drug treatment, including research to support it, or 28.1% of the total. (See Table 7.1 in Chapter 7.) The federal drug control budget increased from a level of $7.05 billion in FY 1995, growing at an annual rate in this period of 6%. The budget for treatment increased from a level of $2.4 billion, growing 3.8% annually. Treatment funds increased their share from 21.7% of total budget to 28.1% (down slightly from FY 2003), but treatment funds grew at a lower rate than the total budget since FY 1995. The two categories that saw higher than average growth were international programs (growing 21.5% a year) and interdiction of drugs at the borders (growing 7.5% a year). The federal budget has exhibited a slight bias toward control of drugs at the source rather than control of demand at home: the lowest annual growth rate was exhibited by programs of prevention (3.8% a year). Domestic law enforcement expenditures, the second-largest category ($3.1 billion in FY 2004) grew at a rate of 5% yearly. Growth trends by category are shown in Table 7.3 in Chapter 7 from FY 1996 through the requested FY 2005 budget.

The bulk of treatment funds in 2004 were earmarked for SAMHSA, the Department of Veterans Affairs, and the Office of National Drug Control Policy. In addition to the treatment funds it spends, SAMHSA also administers grants to states.

Other Sources of Funding

Based on data published by SAMHSA in 1997 (Uniform Facility Data Set (UFDS): Data for 1996 and 1980-1996), 26% of substance abuse treatment funding came from Medicare and Medicaid, 15.8% from private health insurance, and 10.7% from individuals paying for their own services. The rest (48.1%) came from substance abuse programs funded by the federal, state, and local governments. The sources of 4.8% of funds were not known.

STATES AND LOCALITIES.

In 2002, according to its report to Congress (cited above), SAMHSA provided $1.725 billion to states under the Substance Abuse Prevention and Treatment (SAPT) block grant program to states, which represented 40% of state expenditures, suggesting a state contribution of $2.6 billion in 2002 as matching funds to the federal program. Total state expenditures are most likely much higher. Data on local government expenditures are not available.

INSURANCE.

Insurance coverage of substance abuse treatment depends on the provisions of an individual's health insurance policy. In the 1990s, as health care expenses continued to rise, companies cut back on substance abuse treatment coverage. President Clinton ordered health plans covering federal employees to offer equivalent coverage for physical and mental illness and for substance abuse in 1999. In 2001 Senator Paul Wellstone (D-MN) and Representative Jim Ramstad (R-MN) introduced new legislation to accomplish the same end. The legislation is known as Fairness in Treatment: The Alcohol and Drug Addiction Recovery Act of 2001. Ramstad and Senator Norm Coleman (R-MN), who won the seat formerly held by Wellstone, introduced similar legislation in 2003, called the Help Expand Access to Recovery and Treatment (HEART) Act. As of March of 2005, this "parity" legislation had not yet passed. If passed, it would compel insurers to cover addictive disorders just as they do other illnesses.

Spending by/on Individuals

According to SAMHSA, individuals who have no coverage and cannot qualify for a program could expect to pay somewhere between $2,136 and $8,141 for a regimen of treatment in 2002. These are also the estimated costs that must be borne by insurance or by publicly funded programs. The lower end of the cost range is for "drug-free" outpatient care, costing $18 a day and lasting for 120 days. The high end is for long-term residential treatment at $58 per day for 140 days. The figures go back to the last comprehensive survey conducted by SAMHSA in 1997, updated to 2002 values using the medical care services component of the Consumer Price Index (maintained by the Bureau of Labor Statistics). An intermediate cost of treatment is $4,628 for a person on outpatient methadone treatment ($15 per day lasting 300 days) or for a person participating in short-term residential treatment ($154 per day for thirty days).