The CASA Columbia report reveals that addiction and risky use of tobacco, alcohol, and other drugs constitute the largest preventable and most costly health problems facing the US today, responsible for more than 20 percent of deaths in the US, causing or contributing to more than seventy other conditions requiring medical care and a wide range of costly social consequences, and accounting for one-third of all hospital in-patient costs. Research suggests that effective healthcare interventions to prevent and treat addiction would significantly reduce these costs.

  • In 2010 only $28 billion was spent to treat the 40 million people with addiction.
  • $44 billion was spent to treat diabetes, which affects 26 million people;
  • $87 billion was spent to treat cancer, which affects 19 million people
  • $107 billion was spent to treat heart conditions, which affect 27 million people.

“As our nation struggles to reduce skyrocketing healthcare costs, this report makes clear that there are few targets for cost savings that are as straightforward as preventing and treating risky substance use and addiction,” said commission chairman Altman.

Other Notable Report Findings

  • Although addiction is often a chronic disease, treatment typically addresses it as an acute condition and does not include the necessary long-term disease management.
  • Public perceptions do not distinguish between risky substance use and the disease of addiction.
  • Costs to federal, state, and local governments amount to 11 percent of total spending; ninety-five cents of every dollar pays for the consequences while only two cents go to prevention and treatment.


The report offers a comprehensive set of recommendations to overhaul current intervention and treatment approaches, and to bring practice into line with the scientific evidence and with the standard of care for other public health and medical conditions. “It is time for healthcare practice to catch up with the science. Failure to do so causes untold human suffering and is a wasteful misuse of taxpayer dollars,” noted Foster.

For this study, CASA Columbia conducted a thorough review of more than 7,000 publications; in-depth analysis of five national data sets; focus groups and a nationally representative survey of 1,303 adults; statewide surveys of addiction treatment directors and staff providers in New York State; an online survey of 1,142 members of professional treatment associations involved in addiction care; an online survey of 360 individuals with a history of addiction who are managing the disease; and an in-depth analysis of state and federal governments’ and professional associations’ licensing, certification, and accreditation requirements. CASA Columbia also obtained comments and suggestions from 176 leading experts in a broad range of fields relevant to the report.

Founded in 1992 by former US Secretary of Health, education, and welfare Joseph A. Califano Jr., CASA Columbia is a science-based, multidisciplinary organization focused on transforming society’s understanding of and response to the disease of addiction. CASA Columbia conducts research and utilizes the scientific findings of others to inform Americans of the economic and social costs of substance use and addiction and evaluates addiction treatment and prevention programs to determine what treatment models work best, while seeking to reduce the stigma attached to this disease by replacing shame with hope and giving people the tools to prevent and treat addiction.

This blog post is an excerpt from The therapist’s Guide to Addiction Medicine – A Handbook for Addiction Counselors and Therapists – by Barry Solof, MD, FASAM; Published by Central Recovery Press (CRP).