Shoveling Up: The Impact of Substance Abuse on State Budgets | Center on Addiction

Shoveling Up: The Impact of Substance Abuse on State Budgets

Shoveling Up: The Impact of Substance Abuse on State Budgets

Published: January 2001

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This report examines just how much our failure to prevent and treat addiction costs state governments and taxpayers, and where those costs fall.


CASAColumbia’s work for this report involved:

  • An Advisory Panel of members who held considerable expertise in substantive areas relevant to the research, including technical and specialized knowledge about state policymaking and budgeting, substance abuse and addiction and cost-of-illness studies
  • Consultation with researchers from the Urban Institute, the Center for Budget and Policy Priorities, and the Malcolm Weiner Center for the Study of Social Policy at Harvard to inform the study design
  • A detailed survey of state budget offices
  • A review of more than 400 publications, including all existing studies related to calculating the costs of substance abuse and addiction
  • A review of state initiatives in substance abuse prevention and treatment


This 3-year study found that substance abuse and addiction cost state governments at least $81.3 billion in 1998, or 13 cents of every state budget dollar. Of every dollar that state governments spent on substance abuse and addiction in 1998, 95.8 cents went to paying for the burden of this problem on public programs, while only 3.7 cents went to prevention, treatment and research, and 0.5 cents to taxation and regulation.

CASAColumbia looked at 16 areas of state spending, such as criminal and juvenile justice, health care, education, welfare and child welfare, to detect just how many taxpayer dollars the states spent to deal with the financial burden of our failure to prevent and treat substance abuse and addiction.

CASAColumbia found that the $77.9 billion spent on the burden to public programs included:

  • $30.7 billion in the justice system (77% of justice spending)
  • $16.5 billion in education costs (10% of education spending)
  • $15.2 billion in health care costs (25% of health care spending)
  • $7.7 billion in child and family assistance (32% of child and family assistance spending)
  • $5.9 billion in mental health and developmental disabilities (31% of mental health spending)
  • $1.5 billion in public safety (26% of public safety spending)
  • $400 million in substance-related absentee costs for the state workforce


The report details cost-effective methods to reverse these spending patterns, saving taxpayer dollars and reducing human suffering. Specific recommendations for actions by state governments are made in the areas of:

  • Prevention and early intervention
  • Treatment and disease management
  • Tax and regulatory policies
  • Expanded research

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