Cost-of-alcohol studies as a research programme

What are the Economic Costs to Society Attributable to Alcohol Use? A Systematic Review and Modelling Study

BACKGROUND

Alcohol-attributable costs to society are captured by cost-of-illness studies, however estimates are often not comparable, e.g. due to the omission of relevant cost components. In this contribution we (1) summarize the societal costs attributable to alcohol use, and (2) estimate the total costs under the assumption that all cost components are considered.

METHODS

A systematic review and meta-analyses were conducted for studies reporting costs from alcohol consumption for the years 2000 and later, using the EMBASE and MEDLINE databases. Cost estimates were converted into 2019 international dollars (Int$) per adult and into percentage of gross domestic product (GDP). For each study, weights were calculated to correct for the exclusion of cost indicators.

RESULTS

Of 1708 studies identified, 29 were included, and the mean costs of alcohol use amounted to 817.6 Int$ per adult (95% confidence interval [CI] 601.8-1033.4), equivalent to 1.5% of the GDP (95% CI 1.2-1.7%). Adjusting for omission of cost components, the economic costs of alcohol consumption were estimated to amount to 1306 Int$ per adult (95% CI 873-1738), or 2.6% (95% CI 2.0-3.1%) of the GDP. About one-third of costs (38.8%) were incurred through direct costs, while the majority of costs were due to losses in productivity (61.2%).

DISCUSSION

The identified cost studies were mainly conducted in high-income settings, with high heterogeneity in the employed methodology. Accounting for some methodological variations, our findings demonstrate that alcohol use continues to incur a high level of cost to many societies.

REGISTRATION

PROSPERO #CRD42020139594.

Estimating the economic consequences of substance use and substance use disorders

INTRODUCTION

This contribution gives an overview on estimating the economic impact of substance use (SU) and substance use disorders (SUDs) from a societal perspective.

AREAS COVERED

In this Expert Review, we first discuss the scope of the economic costs of SU to society and the methods used to estimate them. In general, cost studies should not be limited to SUDs, but should also include costs related to the consequences of any type of SU to achieve a comprehensive picture of the societal burden. Further, estimating potentially avoidable costs will increase the value of cost studies. Importantly, methodologically sound cost studies shed light on the magnitude of societal problems related to SU and can be used as a reference point to evaluate regulatory policies and other preventive measures. The area of estimating potential economic benefits of SU is understudied and lacks a theoretical and methodological framework.

EXPERT OPINION

Overall, economic studies on the impact of SU and SUDs can strongly contribute to better-informed decision-making in the creation of regulatory and control policies. The least developed area of research refers to a consensus methodology that could be used in studies which compare economic costs to potential economic benefits.

Quantifying the societal cost of methamphetamine use to Australia

Globally, there are increasing concerns about the harms associated with methamphetamine use. This paper i) reports on the results of a cost-of-illness (CoI) study that quantified the social costs associated with methamphetamine use in Australia and, ii) drawing on examples from this study, critically examines the general applicability of CoI studies for the alcohol and other drug field. A prevalence approach was used to estimate costs in 2013/2014, the most recent year for which reasonably comprehensive data were available. The value selected for a statistical life-year in our central estimate was AUD 281,798. Other costs were estimated from diverse sources. Total cost was estimated at AUD 5023.8 million in 2013/14 (range, AUD 2502.3 to AUD 7016.8 million). The greatest cost areas were crime including costs related to policing, courts, corrections and victims of crime (AUD 3244.5 million); followed by premature death (AUD 781.8 million); and, workplace costs (AUD 289.4 million). The social costs of methamphetamine use in Australia in 2013/14 are high, and the identification of crime and premature mortality as the largest cost areas is similar to USA findings and represents important areas for prevention and cost remediation. However, caution is required in interpreting the findings of any CoI study, as there is uncertainty associated with estimates owing to data limitations. Moreover, CoI estimates on their own do not identify which, if any, of the costs are avoidable (with drug substitution being a particular problem) nor do they shed light on the effectiveness of any potential interventions. We also recognise that data limitations prevent some costs from being estimated at all.

Positioning Alcohol's Harm to others (AHTO) within Alcohol Research: A Reinvented Perspective with Mixed Policy Implications

Aims & Design

This overview analyses the recent emergence of the concept of alcohols harm to others (AHTO) and the potential policy implications embedded in this research perspective. The overview is an account of ways in which recent alcohol research has grasped the kind of harm that goes beyond the drinker. It positions the dimensions of alcohol's harm to others as a research perspective in relation to other established research approaches to alcohol-related problems.

Findings

Several concepts presented within different disciplines have focused on how adverse consequences of drinking go beyond the individual drinker. However, the scientific discussion is still characterised by an obvious conceptual instability. Alongside the growing research interest in alcohol's harm to others there is a political discourse stressing the urgency of alcohol policy measures protecting innocent victims against damage from others' alcohol use.

Conclusions

In drawing attention to the interactional nature of alcohol-related harm, the AHTO perspective brings a novel syntagmatic and cross-cutting aspect to established traditions in alcohol research and forms a unique scientific approach. The AHTO perspective has the potential for creating a political will to move the alcohol policy agenda forward, but the question of a suitable and credible term is unresolved. Conceptually, the AHTO perspective is still in a state of flux, while politically it is loaded with considerable ambitions and interests related to causal attributions and ethical conclusions embedded in the research perspective.

Problematizations in Alcohol Policy

This article examines how the issue of alcohol use has been problematized using past and current World Health Organization reports and associated publications as illustrations. The 2010 Global Strategy to Reduce the Harmful Use of Alcohol serves as a salient example. Applying an approach to policy analysis called “What’s the Problem Represented to be?” this article highlights grounding presuppositions in selected alcohol policies and policy proposals. Particular attention is directed to the genesis and continually evolving and changing key concept “alcohol problems” (or “alcohol-related problems” and other variations). The objective is to raise questions about the implications of public health frameworks of meaning around alcohol policy for how governing takes place and for governed subjects. On the basis of this analysis, this article signals the importance of interrogating the meaning and role of taken-for-granted categories of analysis.

Communication of Support in Mutual-Aid Group Meetings for Alcoholics' Friends and Relatives

AIMS – This study examines the kinds of support that alcoholics' friends and relatives provide each other in Al-Anon mutual-aid groups. The study examines, first, the types of supportive communication in Al-Anon meetings and second, how contextual features affect supportive communication in these meetings. DESIGN – The research data were collected through non-participant observations of 11 group meetings and analysed by combined deductive and inductive approaches. RESULTS – Four types of support were detected: emotional, informational, esteem and social network, indicating that meetings serve as potential sources of comfort, learning, self-esteem enhancement and company. Contextual features, such as the 12-step ideology, had an effect on the content and form of supportive communication. CONCLUSION – The key to support in Al-Anon meetings lies in their discretion. That is, the way of communicating support and the contextual features of the meetings established favourable conditions for effective communication of support. The results of this study illustrate the actual communication processes exchanged by the people who have “been there”, providing information useful to anyone in contact with friends or relatives of an alcoholic.