The National Center on Addiction and Substance Abuse at Columbia University (CASA) last week issued a report detailing the spending on substance abuse and addiction at all three levels of government – federal, state, and local. The report was based on three years of research into government expenditures to cover the costs of alcohol, tobacco, and illegal and prescription drug abuse.
Amazingly, it found that the federal government spent $238.2 billion, states spent $135.8 billion, and local governments spent $93.8 billion in 2005. That is a grand total of over $467 billion, or 10 percent of the $4.4 trillion combined yearly budget of all three levels.
Commenting on what he believed to be the most outrageous part of the whole report — namely, that out of the $373 billion spent at the federal and state levels, only 2.3 percent of that went towards prevention, treatment, and research, while a whopping 95 percent went “to shovel up the consequences and human wreckage of substance abuse and addiction” — CASA's founder and director, Joseph Califano said the following:
“With health care costs by far the heaviest burden of shoveling up, to attempt health care reform without providing for prevention and treatment of this disease is like trying to make a Reuben sandwich without corned beef and sauerkraut.”
Thus, the rest of this article will try to explain why more money for preventing and treating drug addiction is the solution to our national substance abuse problem in a way that I'm sure would do Mr. Califano proud — using sandwich analogies.
Current policy is like eating a Dagwood sandwich on a half-full stomach: there's just way too much sandwich to begin with, and it's made out of predominantly unhealthy ingredients. Spending a tenth of the entire government's budget on substance abuse is the same kind of deal. Most of the money spent could be better used in other ways; and not only that, but eating this whole sandwich of money will help the problem in the short run, but it will also stretch out the figurative national stomach and make room for more (and potentially worse) problems down the road.
What Califano and the CASA are recommending, in essence, is a solid BLT on rye. The lettuce and tomato, being chock-full of vitamins and minerals, are the one-two combo of substance abuse prevention and treatment, designed to reduce the amount of money needed in the long run to clean up after the messes substance abusers leave behind. The bacon is more effective taxation and regulatory policies on alcohol and tobacco, policies which have already been implemented in the current Dagwood approach and have produced results already. The rye is increasing research into and knowledge about substance addiction and abuse.
The Dagwood sandwich was naturally on white bread, with very few of the whole grains of research ($1.6 billion out of $467 billion, or about .4%). Making this new sandwich on research rye will help more effectively prevent, treat, and remove the problem of substance abuse in America. Research, as cited in the report, has already shown that “every dollar spent on quality treatment can deliver a return of $12.00 or more in reduced substance-related crime and criminal justice and health care costs.”
The Dagwood is an apt comparison here, too, because while there are lettuce, tomato, and bacon on the Dagwood, they're effectively drowned out by the mayonnaise, provolone, ham, swiss, turkey, pastrami, prosciutto and dijon mustard that really don't need to be there in such quantities if there is a substantial increase in the amount of bacon, lettuce, tomato and rye. Getting back to these four key ingredients is what needs to happen in order to win the battle against substance abuse.
Of course, legislators wary of weaning off the familiar Dagwood diet are concerned about whether or not the BLT plan will actually solve the substance abuse problem plaguing our nation. Perhaps they're wary because it's a smaller sandwich, and the American problem-solving trend is often to “throw more money at it and make it bigger”. Clearly, in this way it flies in the face of accepted doctrine. But in this instance, it does seem like bigger isn't exactly better. And that, I think, is a sandwich worth trying.
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