I think we’re all aware of the ever-growing burden that healthcare costs are placing on our economy. The National Healthcare Expenditure Account (NHEA) found that healthcare spending grew to $3.5 Trillion in 2017, amounting to 17.9% of the U.S. Gross Domestic Product (GDP). Chronic, or persistent, health conditions are among the largest contributors to the astronomical healthcare spending.
The CDC defines chronic disease as a condition that lasts 1 year or more that requires ongoing medical attention and/or limits activities of daily living. Chronic diseases are also thought to be conditions that do not have a cure and could only be managed. Doing a quick Google search will net you the following results about chronic diseases:
- Heart disease and stroke
- Leading cause of death among Americans
- 895,000 Americans die from heart disease or stroke annually
- $199 Billion in healthcare expenditures
- $131 Billion in lost job productivity
- 6 Million diagnosed with cancer annually
- Second leading cause of death (600,000 deaths annually)
- Expected $174 Billion healthcare costs by 2020
- 30 Million Americans diagnosed with prediabetes
- $237 Billion in healthcare costs and loss of employer productivity
- Seen among 1 in 5 children and 1 in 3 adults
- $147 Billion in healthcare costs annually
- Affects 1 in 4 Americans (54 Million)
- One of the most common causes of chronic pain
- $304 Billion economic impact in 2013
- $140 Billion in medical expenses
- $164 Billion from indirect costs and lost earnings
- Alzheimer’s Disease
- Affects 5.7 million Americans
- Sixth leading cause of death among adults
- $159 – $215 Billion in healthcare costs in 2010
It’s obvious that chronic diseases make a significant impact on healthcare expenditures and lost earnings in the US. Yet, site after site, and any Google search will give you the same list of chronic conditions. Why isn’t substance abuse disorder on this list?
Substance Abuse Disorder
Prior to 1980, substance abuse disorder was not classified as a primary mental health disorder. The third iteration Diagnostic and Statistical Manual of Mental Disorders (DSM-III) finally added substance abuse disorder to the list of primary mental health disorders. It defined to be when a person’s use of alcohol or another substance (drug) leads to health issues or problems at work, school or home.
Addiction, the underlying cause of substance abuse disorder, is known to create physiological changes in the prefrontal cortex of the brain. The pre-frontal cortex has important functions dealing with behavior and cognitive activities (executive function): self-monitoring, delaying reward, and the intermingling of intellect and libido. Without getting too far into the details, substance abuse leads to a set of self-reinforcing loops which are reinforced by increased levels of neurotransmitters (mainly dopamine) with in the brain. Once the chemical is removed from the blood, it becomes difficult for the brain to achieve the same levels of satisfaction or pleasure from every day activities like having a good conversation with a loved one. These physiological changes in the brain may be further compounded by other cognitive, psychological, physical, and environmental factors.
Compared to chronic diseases, substance abuse disorder holds its own.
- 5 million adults (age 18+) re in recovery from alcohol or drug addiction
- 2% receive help for their addiction in a specialized facility
- 23 million Americans (ages 12+) need treatment for substance abuse disorders
- 10% receive the treatment
- Alcohol, illicit drug, and prescription opioid costs amount to $520.5 Billion annually
- $64 Billion in healthcare expenditures
- $456.5 Billion in costs related to crime and lost work productivity
The non-healthcare related economic impact of substance abuse disorders is three times larger than that of over chronic diseases. However, healthcare costs amount to no more than half of the cost of chronic diseases across the board. 85% of the 30 million diabetics in America receive treatment. Yet, ONLY 10% of the 23 million Americans suffering from substance abuse disorder are receiving the treatment they need. A large healthcare disparity continues to exist within the addiction and substance abuse industry because there aren’t enough solutions on the table.
Addiction is a Chronic Disease
It is known that the neurophysiological changes that occur in the brain due to substance abuse are difficult to reverse because of the self-perpetuating loops that occur in the prefrontal cortex. These areas in the brain remain sensitive to chemical substances for a lifetime. It may take several months, if not years for the brain to return to normal levels of physiological function.
Is this enough to qualify substance abuse disorder to be chronic? I believe it is. Given disease timeframe and lack of a cure, substance abuse disorder should be listed on ANY and EVERY website talking about chronic diseases. Furthermore, the economic impact is greater than any of the chronic diseases listed. Again, there may be several other, namely societal, issues that may be impacting why substance abuse disorder and other mental health illnesses have taken a back seat to the above chronic disease list… All topics we hope to dive into in the near future.