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Substance Use Disorders and Health Care Costs Among Veterans Affairs Nursing Home Residents

Smith, Mark W. PhD*,†; Lemke, Sonne PhD; Schaefer, Jeanne PhD

doi: 10.1097/MLR.0b013e318207f257
Original Articles

Background Research on the relationship between substance use disorders (SUDs) and older adults' health care costs is equivocal. A large-scale study comparing health care costs among older adults with and without SUDs has never been conducted.

Objective To determine the relation of SUDs to health care costs in a large sample of adults following entry into a Veterans Affairs (VA) nursing home.

Methods We performed a retrospective analysis of 29,997 adults aged 45+ who entered a VA nursing home in 2000. Total costs were tallied over fiscal years 1997 to 2000 by setting (outpatient, nursing home, other inpatient, and total) and included all care paid by VA.

Results Relative to non-SUD patients, those with SUDs aged 75 to 84 years had significantly higher total costs of care (+$10,020), as did those aged 85 and above (+$16,052). Yet, SUD diagnosis was not a significant predictor of total cost or nursing home cost among persons 65 and above after controlling for demographic, clinical, and financial factors.

Conclusions SUDs do not directly increase health care costs among older adults entering nursing homes, although they may affect cost of care indirectly through factors such as income and marital dissolution. The generational increase in SUD rates occurring in the United States may not lead to substantially greater health care expenses if appropriate assistance can be provided before nursing home entry.

Supplemental Digital Content is available in the text.

*Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA

Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, CA

Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, CA

Supported by the Health Services Research and Development Service, US Department of Veterans Affairs, under grant IIR 03-243.

The views and conclusions expressed herein are not necessarily those of the US Department of Veterans Affairs.

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site,

Reprints: Sonne Lemke, PhD, Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA 94025. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.