Articles

Alcohol has an impact on the health care systems as well. Studies have consistently shown that a minimum of 20% of all hospitalized persons have a significant alcohol problem, whatever the presenting problem or admitting diagnosis. That is an absolute minimum. A recent study indicated that the figure is more likely to be one third of all hospitalized persons. For the Veterans Administration, estimates are higher— 50% of all VA hospital beds are filled by veterans with alcohol problems.

In terms of health care costs, alcohol figures prominently in our nation's annual medical bills to the tune of $14.9 billion. That $14.9 billion is equivalent to 12% of all adults' health expenditures. However, it appears that some people incur a disproportionate share of the costs. One large-scale study of hospital costs found that a small proportion of patients, only 13%, had hospital bills equal to the remaining 87%. The distinguishing characteristic of the high-cost group was not age, or sex, or economic status, or ethnicity. It was that those people were heavy drinkers and/or heavy smokers. Furthermore, a follow-up study found that high-cost users also had multiple hospitalizations. Those patients with a history of alcoholism had significantly more repeated hospitalizations than those without a history of alcoholism.

It is very unfortunate and ironic that of these health care costs, only a small proportion—13%— represents expenditures for rehabilitation or treatment of the primary alcohol problem. The bulk of the costs are for treatment of alcohol-induced illness and trauma. Equally disturbing is that the NIAAA estimates that approximately 85% of the nation's alcoholics and problem drinkers are not receiving any formal treatment. Even if one were to factor in the members of AA, who enter without involvement in formal treatment (i.e., approximately two thirds of the 1 million members of AA), that only reduces the "untreated" portion by another 5%!

Another recently recognized health care cost is that which accompanies fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). It is estimated that the current annual costs of treatment and the special education, training, and support services required add another $2.4 billion to the costs for our nation's health care. These infants grow to become children and eventually adults who will continue to require care.

If one considers the federal dollars spent on health research, alcohol is a health concern that is getting short shrift. For example, if one looks at the costs, both direct and indirect, associated with alcohol and heart disease, they are very similar—43 to 46 billion dollars, respectively. However, in terms of federal expenditures for research, 15 times more is spent on research on heart disease than alcoholism and alcohol abuse. And the amount spent on cancer research is 35 times greater, although the associated costs are only three quarters of those associated with alcohol abuse and alcoholism.

When it comes to health insurance, alcohol treatment and rehabilitation do not fare very well. Despite numerous studies that demonstrate that treating alcoholism is cost effective, and that any treatment is better than no treatment, alcoholism remains the only common major disease not routinely covered by health insurance. In 1982, 20 states had mandatory coverage of alcoholism for insurance sold in that state, 15 required alcoholism coverage as an option; and 15 had no requirements.

Surveys of American attitudes toward alcohol use and alcohol problems have consistently indicated a growing public awareness of the dimensions of the problems related to alcohol use, an ever broadening acceptance of the view that alcoholism is a disease and belief that it should be treated as any other medical illness.

There is more awareness of the toll that alcoholism and alcohol abuse can take in our public and private lives. What people will individually and collectively do with this knowledge is the question. Statistics in future years will reflect the answer.

Alcohol is a drug. When it is ingested, there are specific and predictable physiological effects on the body. Any body. Every body. Alcoholic and nonalcoholic. This is all too often overlooked. Instead, attention is paid to the physical impact of chronic use or what happens with excessive use. What gets lost are the normal, routine effects on anyone who uses alcohol. Let us examine what happens to alcohol in the body, how it is taken up, broken down, and thereby alters the normal functions of the body.

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