With substance abuse now accounting for one in 14 hospital admissions and generating billions in health care costs, leading scientists held a briefing on Capitol Hill Oct. 2 to present the evidence that we already have and the evidence we need in treating and preventing the use and abuse of alcohol, drugs and tobacco.
Scientists affiliated with the Robert Wood Johnson Foundation's (RWJF) Substance Abuse Policy Research Program (SAPRP) identified steps that federal, state and local governments could take now to reduce the $2 billion healthcare burden from alcohol, drugs, and tobacco use and abuse. They also provided a roadmap for research over the next five years to deal with future challenges in reducing substance abuse.
A. Thomas (Tom) McLellan, PhD, deputy director of the White House Office of National Drug Control Policy, moderated the briefing.
"The Foundation is immensely proud of our decision to establish the Substance Abuse Policy Research Program," said David Colby, PhD, Vice President of Research and Evaluation at RWJF. "It's gratifying to see such quality research from a cadre of top-notch researchers who are leading lights in their field."
"As important," continued Colby, "The foundation's investment in substance abuse policy research has produced an extensive body of knowledge that has been front and center in the most important policy debates and decisions on tobacco, alcohol and illegal drugs over the past 20 years. The research agenda for the future that we presented today will be the legacy of our investment in reducing the harm caused by substance abuse," Colby said.
The research roadmap covered treatment of drug and alcohol use disorders, preventing drug abuse, preventing alcohol abuse, and policies to achieve a smoke-free society.
Policies for the Treatment of Alcohol and Drug Use Disorders: Dennis McCarty, PhD, of the Oregon Health and Science University, noted that research has shown that 23 million Americans—9 percent of the population aged 12 and older—meet the criteria for substance use, abuse or dependence. But only 4 million people get the care they need.
"We need research that explores the policy measures that might make a difference in closing the huge gap between the number of people who need care and the numbers who actually receive it," McCarty said. "Policymakers also need more data on the economic benefits of treatment and the relationship between the cost of care and quality of care."
Policies to Prevent Drug Problems: Marjorie Gutman, PhD, co-director of SAPRP, noted that given the national focus on preventing drug use in young people, there is a need for more research on school-based programs in order to pinpoint successful interventions. She said that while drug-testing for students has attracted considerable interest, studies have found it is a low priority in most states and school districts and that there is little evidence to show that testing students actually deters drug use.
Gutman also discussed recent research documenting a sharp increase in emergency room visits and deaths from prescription pain killers, like oxycodone, that contain opiates. She said studies indicate in most instances, the drugs involved came from a friend or relative or were obtained from a doctor.
Policies to Prevent Alcohol Problems: Harold Holder, PhD, Prevention Research Center, Pacific Institute for Research and Evaluation (PIRE), discussed research exploring prevention, availability and pricing initiatives designed to deter alcohol abuse.
He pointed out that today, federal funding for alcohol prevention programs is dispensed without requiring evidence of a program's effectiveness.
"Yet researchers have generated considerable evidence on the effectiveness of policies including minimum drinking ages, a tougher approach to drunk driving, and raising alcohol taxes," he said.
For example, there is evidence that increasing alcohol taxes to keep pace with inflation would lead to a 19 percent reduction in heavy drinking by youth and a 6 percent reduction in high-risk drinking. Research also has shown that simply changing licensing provisions and modifying hours of service at establishments that sell alcohol can have a significant effect on drinking and drinking-related problems.
"What policymakers need now is research that helps them decide on the best mix of strategies that are likely to be most effective at preventing alcohol problems," he said.
Policies to Achieve a Smoke-Free Society: Michael Cummings, PhD, MPH, of the Roswell Park Cancer Institute discussed the tremendous progress in smoking prevention and cessation that has occurred over the last two decades, but pointed out that smoking continues to the leading cause of preventable death and disease and major reason for high health care costs in the U.S.
He noted that for all the money invested in finding cures for cancer, most of the recent reductions in cancer deaths have been achieved by tobacco control efforts, especially efforts to convince and assist smokers to quit.
He said researchers have shown that policies such as higher tobacco prices can significantly reduce smoking. Cummings also pointed to research showing that bans on smoking in workplaces, restaurants and bars increase the chance a smoker will successfully quit.
What is needed now, he said, is more evidence on what level of tobacco price increases produces the maximum health impact. There is also a need for studies that explain why comprehensive smoke-free air laws are less prevalent in certain regions like the South, according to Cummings. He also drew attention to the fact that a law enacted earlier this year to place tobacco under the control of the Food and Drug Administration (FDA) presents new opportunities to address issues related to the toxic properties of tobacco products.
"There is a wide variation in nicotine yields and carcinogens in tobacco products and considerable research will be needed on tobacco toxins if the FDA is to pursue new regulations to set maximum levels of exposure," he said.
Materials provided by Substance Abuse Policy Research Program. Note: Content may be edited for style and length.
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