Cost of specialized addiction treatment of clients with fetal alcohol spectrum disorder in Canada
BMC Public Health
Cost of specialized addiction treatment of clients with fetal alcohol spectrum disorder in Canada
Svetlana Popova 0 1
Shannon Lange 0 1
Larry Burd
Karen Urbanoski 0 1
Jrgen Rehm 0 1
0 Dalla Lana School of Public Health, University of Toronto , 155 College St, Toronto, ON M5T 3M7 , Canada
1 Social and Epidemiological Research Department, Centre for Addiction and Mental Health , 33 Russell St., Toronto, ON M5S 2S1 , Canada
Background: Individuals with Fetal Alcohol Spectrum Disorder (FASD) constitute a special population that may be at particularly high risk for substance use. The purpose of the current study was to estimate the utilization of specialized addiction treatment services (SATS) and the associated cost, as a part of the total cost of health care associated with FASD in Canada. Methods: The current study was a modeling study. Data on SATS by lifetime mental disorder status were obtained from the Drug and Alcohol Treatment Information System (DATIS) in Ontario, Canada for 2010/11. The number of clients with FASD who received SATS in Ontario in 2010/11 was estimated, assuming that approximately 37% (confidence interval: 21.6%-54.5%) of individuals with FASD abuse or are addicted to alcohol and/or drugs and that their utilization rate of SATS is the same as those for people with a lifetime mental disorder. The data from DATIS was then extrapolated to the total Canadian population. Results: The cost of SATS for clients with FASD in Canada in 2010/11 ranged from $1.65 million Canadian dollars (CND) to $3.59 million CND, based on 5,526 outpatient visits and 9,529 resident days. When the sensitivity analysis was performed the cost of SATS ranged from $979 thousand CND to $5.34 million CND. Conclusions: Special attention must be paid to at-risk groups of individuals such as those with FASD, in order to reduce the likelihood of the development of co-morbid substance abuse problems, and thus, reducing the overall burden on Canadian society.
Fetal alcohol syndrome; Fetal alcohol spectrum disorder; Addiction; Specialized treatment; Utilization; Cost; Canada
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Background
This study is a part of a large economic study on the
estimation of the burden and cost associated with Fetal
Alcohol Spectrum Disorder (FASD) in Canada [1,2]. FASD is a
non-diagnostic term that encompasses four alcohol-related
clinical diagnoses, including: Fetal Alcohol Syndrome
(FAS), Partial FAS, Alcohol-Related Neurodevelopmental
Disorder, and Alcohol-Related Birth Defects.
Individuals with FASD have an increased vulnerability
to certain risk factors, which put them at a higher risk
for substance use/abuse problems, as a result of the
damage caused to their central nervous system due to
their exposure to alcohol prenatally. This damage
manifests as developmental delays, cognitive impairments,
mental disorders, high rates of incarceration and an
increased rate of substance abuse [3-5].
The impairments expressed by individuals with FASD
typically lead to high-risk behaviours, such as alcohol/
drug abuse or an increased likelihood of being in
highrisk situations (increasing the chance of being exposed
to alcohol and/or drugs). Currently, there are not
many epidemiological studies reporting on the prevalence
of substance use/abuse among individuals with FASD.
However, the literature does indicate that a
disproportionate number of individuals with FASD will have
problematic substance use issues at some point in their lives
[6]. For instance, Famy et al. [7] reported a prevalence of
55% for alcohol/drug dependence among their sample of
individuals with FAS. Additionally, Clark and colleagues
[8] and Streissguth and colleagues [9] reported that 22%
and 35% of their respective cohorts of individuals with
FASD had problems with alcohol/drugs. Lastly, in a
study conducted by Grant and colleagues [10], about
68% of women with FASD had reported abusing alcohol
and 79% had used illegal drugs in the 10 months prior
to being admitted into a community program.
There are a few potential explanations for the high
prevalence of substance use among individuals with
FASD: 1) a biological vulnerability to substance use
may exist; 2) individuals with FASD may use substances
to self-medicate; and 3) individuals with FASD tend to
have difficulties with impulse control, making them
susceptible to developing a substance use disorder [11].
Regardless of the reason for such high rates of
cooccurring substance use problems and FASD, this
population places a greater demand on treatment
service providers, given that they suffer from multiple
comorbid mental disorders [8,12,13].
Prenatal alcohol use exposes three generations to the
harmful effects of alcohol (the mother, the fetus, and the
germ line of the fetus). Increased rates of substance
abuse increase the risk for additional familial cases of
FASD (multiple affected siblings), and increase the risk
of generational FASD [3,14]. Therefore, it is also
important to address the issue of women (...truncated)