Longitudinal Trends in Hospital Admissions with Co-Occurring Alcohol/Drug Diagnoses, 1994-2002

Alcohol/drug abuse and addiction (ADAA) are among the most serious health problems in the United States, both in terms of mortality and cost. Annual combined costs of health care, lost productivity and crime are estimated at $365 billion per year. This longitudinal study examines long-term trends in hospital admissions where patients had co-occurring ADAA, to determine prevalence and hospital costs by payer group and type of drug used. Although individuals with ADAA frequently have other illnesses, mental and physical, and are admitted to hospitals at much higher rates than the general population, large studies of hospitalization rates in people with ADAA are rare.

The authors analyzed records of all adults admitted to Johns Hopkins Hospital between 1994–2002 who had a concurrent diagnosis of ADAA. This amounted to 43,073 admissions, or 13.7 percent of total admissions during that period. Their study had three major findings: (1) the number of admissions with concurrent ADAA grew 50 percent, but the costs of these patients grew 134 percent; since only one percent of patients had a primary diagnosis of ADAA, most of these costs were associated with other conditions; (2) Medicaid/Medicare paid 70 percent of costs; and  (3) Medicaid/Medicare admissions and uninsured people had the highest likelihood of using illicit drugs, while private insurance admissions had the highest likelihood of using alcohol. The authors also found high rates of heroin use, likely due to very high use of this drug in Baltimore. Concurrent alcohol admissions remained stable at about 25 percent, but accounted for disproportionately (35%) higher costs.

This research indicates that failure to provide ADAA treatment is placing a heavy burden on the health-care system, particularly Medicaid and Medicare. Most individuals with ADAA are not receiving treatment for their condition, and U.S. spending on ADAA treatment has now declined to 1.3 percent (1991 data) of all health care spending. The authors note that, although their study is one of the largest on the topic, limitations remain. The study may have underestimated concurrent ADAA admissions, because many primary care physicians do not screen for these conditions, or are reluctant to record this information in patients' charts. Lastly, costs associated with ADAA may be overestimated if reasons for admission are unrelated to the concurrent ADAA.