Review and special article
Economic Costs of Excessive Alcohol Consumption in the U.S., 2006

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Background

Excessive alcohol consumption causes premature death (average of 79,000 deaths annually); increased disease and injury; property damage from fire and motor vehicle crashes; alcohol-related crime; and lost productivity. However, its economic cost has not been assessed for the U.S. since 1998.

Purpose

To update prior national estimates of the economic costs of excessive drinking.

Methods

This study (conducted 2009–2010) followed U.S. Public Health Service Guidelines to assess the economic cost of excessive alcohol consumption in 2006. Costs for health care, productivity losses, and other effects (e.g., property damage) in 2006 were obtained from national databases. Alcohol-attributable fractions were obtained from multiple sources and used to assess the proportion of costs that could be attributed to excessive alcohol consumption.

Results

The estimated economic cost of excessive drinking was $223.5 billion in 2006 (72.2% from lost productivity, 11.0% from healthcare costs, 9.4% from criminal justice costs, and 7.5% from other effects) or approximately $1.90 per alcoholic drink. Binge drinking resulted in costs of $170.7 billion (76.4% of the total); underage drinking $27.0 billion; and drinking during pregnancy $5.2 billion. The cost of alcohol-attributable crime was $73.3 billion. The cost to government was $94.2 billion (42.1% of the total cost), which corresponds to about $0.80 per alcoholic drink consumed in 2006 (categories are not mutually exclusive and may overlap).

Conclusions

On a per capita basis, the economic impact of excessive alcohol consumption in the U.S. is approximately $746 per person, most of which is attributable to binge drinking. Evidence-based strategies for reducing excessive drinking should be widely implemented.

Introduction

Excessive alcohol consumption is responsible for an average of 79,000 deaths and 2.3 million years of potential life lost in the U.S. each year,1 making it the third-leading preventable cause of death in this country.2 Excessive alcohol consumption is associated with multiple adverse health and social consequences, including liver cirrhosis, certain cancers, unintentional injuries, violence, and fetal alcohol spectrum disorder. Excessive alcohol consumption also causes premature death, increased healthcare costs, property damage from fire and motor vehicle crashes, increased crime and criminal justice system costs, and lost worker productivity in the form of missed work, diminished output, and reduced earnings potential.

A comprehensive analysis3 estimated the 1992 economic cost of alcohol abuse at $148 billion; a 1998 update4 put the figure at $184.6 billion. Since then, there have been no comprehensive national estimates of the costs of excessive alcohol consumption.5 Current estimates are needed to more fully assess the public health impact of excessive drinking. Accordingly, the purpose of the present study (conducted 2009–2010) was to update prior national estimates of the economic costs of excessive drinking.

The 2006 estimates reported here employ updated data, as well as new data sources and take advantage of new scientific findings and measurement tools (e.g., Alcohol-Related Disease Impact [ARDI] software created by the CDC)6 that can more effectively assess the relationship between excessive drinking and various health and social outcomes. Addressing the benefits of excessive alcohol consumption was beyond the scope of the current study. Studies such as this one focus solely on identifying and quantifying the societal costs of excessive drinking.

Section snippets

General Approach

The present study follows the approach in Guidelines for Cost of Illness Studies in the Public Health Service.7 In brief, this approach estimates the proportion of national costs for health care; crime; mortality- and morbidity-associated productivity; and other expenses that can be reasonably attributed to a particular behavior or health problem. This same approach was used by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to assess the economic cost of alcohol misuse in 1992

Results

The estimated total economic cost of excessive drinking was $223.5 billion in 2006. On a per capita basis, this cost was approximately $746 for each man, woman, and child in the U.S. in 2006.17 Of the total cost, $161.3 billion (72.2%) came from lost productivity; $24.6 billion (11.0%) came from increased healthcare costs; $21.0 billion (9.4%) came from criminal justice costs; and $16.7 billion (7.5%) came from other effects (Table 1). The cost associated with binge drinking was $170.7 billion,

Discussion

The estimated $223.5 billion cost of excessive drinking in 2006 is on a par with the costs of other major health-risk behaviors. For example, smoking currently costs the U.S. about $193 billion annually—$97 billion from lost productivity and about $96 billion in healthcare costs.21, 22 The total direct and indirect cost of physical inactivity was estimated to be in excess of $150 billion in 2000.23

Comparing the 2006 estimates to those from 1992 and 19983, 4 is problematic because there were

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