Of the $373.9 billion spent by federal and state governments on tobacco, alcohol, and other drug abuse and addiction only a fraction is spent on prevention and treatment, according to a report released Thursday by Joe Califano’s National Center on Addiction and Substance Abuse (CASA).

According to the report, 95.6% of these expenditures were spent to "shovel up the consequences and human wreckage of substance abuse and addiction," while only 1.9 percent was spent on prevention and treatment.

In fact, for every dollar spent to prevent and treat alcohol, tobacco and other drug abuse, federal and state governments spent more than $50 on public programs aimed at addressing its effects, the report says.

"Despite a significant and growing body of knowledge documenting that addiction is a preventable, treatable and manageable disease, and despite the proven efficacy of prevention and treatment techniques, our nation still looks the other way while substance abuse and addiction cause illness, injury, death and crime, savage our children, overwhelm social service systems, impede education -- and slap a heavy and growing tax on our citizens," Susan Foster, the addiction center's vice president and director of policy research and analysis, said in a written statement.

The center found that federal, state and local governments spent some $467.7 billion on substance abuse-related costs, including health care, criminal justice systems, family courts, child welfare, and homelessness in 2005, the most recent year for which data was available over the course of the study. The report, "Shoveling Up II: The Impact of Substance Abuse on Federal, State and Local Budgets," resulted from three years of research and analysis, according to the addiction center

The vast majority of state and federal spending, 71.1%, was spent on the criminal justice system and health care, the report says. "Increasing costs in these areas are devastating state budgets, while health care costs are consuming a larger and larger share of federal spending. "The center found that if substance abuse and addiction were its own category within the federal budget, it would rank sixth in size, behind social security, national defense, income security (welfare), Medicare, and other health programs including the federal share of Medicaid, consuming 9.6 percent of the entire budget.

For states, 15.7% of budgets were spent on substance abuse, which is up from 13.3% in the 2001 "Shoveling Up" report, which examined only state spending. If substance abuse were a state budget category, it would rank second, behind elementary and secondary education. "States spend more on substance abuse and addiction than they spend on Medicaid, higher education, transportation or criminal justice," the report says.

For every $100 state governments spent on substance abuse, they spent an average of $2.38 on prevention, treatment and research, the study found. Connecticut spent the most, at $10.39 of every $100; New Hampshire the least, at 22 cents.

In every case, the authors of the report said, they made the most conservative assumptions and because of data limitations they couldn't even figure in some costs, such as tobacco and drug-related developmental disabilities and highway accidents linked to illicit or prescription drug use. As a result, the actual amounts spent are likely even higher.

The report advocates that more funding and efforts be directed toward prevention and treatment, rather than cleaning up the wreckage that abuse of alcohol, tobacco and other drugs leaves in its wake.

"Under any circumstances, spending more than 95% of taxpayer dollars on the crime, health care costs, child abuse, domestic violence, homelessness and other consequences of tobacco, alcohol and illegal and prescription drug abuse and addiction, and only 2 percent to relieve individuals and taxpayers of these burdens, is a reckless misallocation of public funds," said Joseph Califano Jr., the former U.S. Secretary of Health, Education and Welfare who founded CASA and serves as its chairman. "In these economic times, such upside-down-cake public policy is unconscionable. It's past time for this fiscal and human waste to end."

The report calls for a sharper focus on prevention, especially aimed at children. It points to the success of the American Legacy Foundation's "Truth" campaign on youth smoking, and says similar campaigns are needed to target drug abuse and underage drinking.

Merely blaming those who made the choice to begin using alcohol or drugs or to start smoking does not work, the report points out. "When use of these substances progresses to the point of meeting medical criteria for abuse or addiction, changes have occurred in the brain which make cessation of use extraordinarily difficult. ... The bottom line is that while an individual is responsible for his or her actions related to the disease, the disease must be treated."

But perhaps one of the most important recommendations in the report is this: America needs to shift its culture and attempt to dispel stigmas surrounding substance abuse. The center points to a similar shift that occurred regarding the AIDS/HIV: "In a matter of a few years, AIDS went from being seen as a social curse to being recognized as a serious, treatable disease. It's time for the public health community to mount a similar effort with respect to alcohol and other drug abuse and addiction, to move the nation from stigmatizing it to recognizing it as a disease." The public health community has, in fact, already launched such a campaign. The NAPHP Council on Illicit Drugs has joined in a coalition known as Faces & Voices of Recovery that is engaged in organizing and mobilizing the millions of Americans in long-term recovery from alcohol and other drug addiction, their families, friends, and allies to speak out with one voice on addiction and recovery. They are "dedicated to changing public perceptions of recovery, promoting effective public policy in Washington and in all 50 states, and demonstrating that recovery is working for millions of Americans".