Author: James Anderson

The Cost of Excessive Alcohol Use Infographics Online Media Alcohol

The authors have no other relationships or activities that could appear to have influenced the submitted work. Excessive alcohol use cost states and the District of Columbia (D.C.) a median of $3.5 billion in 2010, ranging from $488 million in North Dakota to $35 billion in California. Had the highest cost per person ($1,526, compared to the $807 national average), and New Mexico had the highest cost per drink ($2.77, compared to the $2.05 national average). If you’re regularly abusing alcohol, this may happen more often than you’d like, causing you to miss work to recover or underperform while on the job. Over time, your paid time off (PTO) for sick days or vacation may run out and you’ll have to go without pay any time you stay home from a hangover.

For (b), we divided the costs by the respective study weights, separated for the two cost indicators, thus correcting for omissions of relevant cost components. Achieving a reduction in the harmful use of alcohol in line with the targets included in the SDG 2030 agenda and the WHO Global Monitoring Framework for Noncommunicable Diseases requires concerted action by countries, effective global governance and appropriate engagement of all relevant stakeholders. Despite numerous pleas to standardize the methodology (e.g. Møller and Matic [14]), we are still faced with a situation in which many different methodologies to estimate these costs have been used over the past decade [13].

Your significant other may also try and make up excuses for your drinking or improper conduct at social functions. This can be a heavy burden for them to carry and may place a distance between their friends and family as well. A  causal relationship has been established between harmful drinking and incidence or outcomes of infectious diseases such as tuberculosis and HIV. Though in many states there are protections in place to prevent hiring discrimination based on DUIs and misdemeanors, the reality of it is that sometimes having a DUI or other alcohol-related offense on your record could reduce the chances of getting a job offer. Due to the nature of their work, some companies also have policies against employing drivers with DUIs such as Uber and Lyft. Online tools such as an alcohol spending calculator can be helpful in seeing how much you may be spending by drinking daily.

Factors affecting alcohol consumption and alcohol-related harm

State excise taxes, for the most part, have followed the same patterns as Federal taxes, with only infrequent and modest increases that have resulted in substantial declines over time in the real values of these taxes. The degree to which the real value of the State taxes has dropped depends on the inflation rate and the latest tax rates imposed by a given State. More than 20 States have not raised their beer taxes for at least 20 years, and only about 10 States have raised them in the last decade.4 In some extreme cases, the deflated tax rates per drink have even declined to close to zero. For example, the nominal State beer excise tax in Wyoming was 2 cents per gallon in 2009, and it had been set since 1963. Estimates indicate that from 1951 to 2009, the average real State beer tax has fallen from almost 42 cents per gallon to just over 11 cents per gallon (see figure 2) (Beer Institute 2009). For the two cost indicators (Int$ per adult; % GDP) and separately for the total costs, and the direct and indirect costs, weighted means were calculated to estimate average costs across all studies.

1. † Largest number of drinks consumed on an occasion in the past 30 days among adults who reported binge drinking.
2. These options include, but are not limited to, regulations on wholesale and retail distribution, bans on price-related promotions, and (targeted) minimum-pricing policies.
3. 3License States are States that adopt a mixed set of regulations to influence the extent of competition in alcoholic beverage markets rather than directly control distribution and sale of these beverages.
4. Moreover, Laixuthai and Chaloupka (1993) reported that younger adolescent drinkers were more price sensitive than older adolescent drinkers, which is a particularly important finding because Cook and Moore (2001) provided evidence supporting the notion that drinking habits are formed at young ages.
5. In fact, variations in indirect costs, the main driver of total costs, are primarily driven by average wages, which are known to vary greatly between countries, even in rather homogenous regions with a common market, such as Europe.

Many studies have shown that not only social drinking but also abusive drinking (i.e., alcohol dependence and/or binge drinking) is responsive to price, although apparently to a lesser extent. Although the findings are mixed about the relative price sensitivity of abusive and nonabusive drinkers, most studies have reported that heavy/frequent drinkers normally are less responsive to price changes than light/infrequent drinkers. Thus, the estimated price elasticity of abusive drinkers ranges from −0.01 to −0.10 (Chaloupka and Laixuthai 1997; Chaloupka and Wechsler 1996; Cook and Moore 2000; French et al. 2006; Keng and Huffman 2007; Kenkel 1993, 1996; Laixuthai and Chaloupka 1993, Sloan et al. 1995; Stout et al. 2000). A more recent review of 10 studies on the effects of alcohol prices on various measures of alcohol abuse indicated that the average price elasticity was −0.28 (Wagenaar et al. 2009).

Correlation of the Two Cost Indicators

Alcohol use has been identified as a major risk factor for burden of disease [1–3], leading to the introduction of reduction goals in major UN and other international frameworks, such as the Sustainable Development Goals [4, 5]. However, alcohol consumption differs from many other risk factors, as attributable health burden is not restricted to the drinker alone but also extends to others, including those who have abstained from alcohol during their lifetime (e.g. via drunk driving or maternal alcohol consumption [6]). Furthermore, harm attributable to alcohol is not restricted to health but comprises many other aspects of life and sustainable development, such as criminal behaviour [7] and loss of economic productivity (e.g. Rehm et al. and Thavorncharoensap et al. [8, 9]).

By comparison, the economic costs of excessive drinking in 2006 were estimated at $223.5 billion (Bouchery et al. 2011). In other words, people who do not use alcohol have been subsidizing alcohol users, especially the top 20 percent of drinkers who consumed approximately 85 percent of all alcoholic beverages (Rogers and Greenfield 1999). Several studies have addressed the effects of alcohol prices on the drinking behaviors of youths and young adults. This population is of particular relevance because they exhibit relatively high levels of binge drinking and of alcohol-related problems; moreover, there seems to be great potential for using tax and price policies to prevent underage drinking.

Lastly, indirect costs were mostly calculated following a human capital approach, which make the findings more comparable, but introduces the risk of overestimation costs as the underlying assumptions may not hold true. Costs calculated under the human capital approach heavily depend on the discount rate, yet there is no consensus on which rate is to be used [14]; thus, this will continue to be a limitation when comparing cost studies. We calculated two indicators to compare the economic costs attributable to alcohol use across different countries and years. In other words, this measure described the tangible costs attributable to alcohol in 2019 Int$ per adult. Second, we calculated a cost equivalent as a percentage of the GDP by dividing the estimated costs by the location-specific GDP of the same year for which costs were estimated.

These investigators failed to detect a significant relationship between tax rates and drinking-and-driving rates. Likewise, Dee (1999) and Young and Likens (2000) found that there was little relationship between beer taxes and motor-vehicle fatalities, and the significance of the relationship was very sensitive to the specification of regression models. As one explanation for these inconsistencies, Mast and colleagues (1999) argued that the minimum legal drinking ages had been higher in the later years of data collection, which means that beer taxes had become a smaller part of the “full price” of teen drinking. Another potential explanation comes from the distinction between alcohol-related and non–alcohol-related traffic fatalities. Thus, studies that do not separate alcohol-related fatal crashes from non–alcohol-related crashes may come to different conclusions than studies that do make this distinction (Elder et al. 2010; Fell et al. 2009; Miron et al. 2008). In contrast to previous reviews on the economic burden of alcohol use, we provide several novel insights.

Finally, Yamasaki and colleagues (2005) demonstrated that increases in alcohol taxes correlated significantly with suicides in male but not in female subjects. These inconsistencies regarding the relationship between prices of alcoholic beverages and suicide may result from measurement errors in the dependent variable, because not all suicides were alcohol related. In fact, according to a meta-analysis by Smith and colleagues (1999), blood alcohol concentrations (BACs) indicative of intoxication (BAC more than or equal to 100 mg/dL) were found in a much smaller percentage of suicide cases (i.e., 22.7 percent) than of homicide cases (31.5 percent). In general, a meta-analysis based on 11 independent estimates from four studies indicated that the impact of prices of alcoholic beverages on suicide only was marginally significant (Wagenaar et al. 2010). To date, evidence such as the findings presented here has had little impact on public policy, with the Federal Government and most State governments allowing the inflation-adjusted value of their alcoholic beverage taxes to fall as demonstrated by the infrequent and modest increases in these taxes. In contrast, the Federal Government and many State governments have adopted several large increases in taxes on cigarettes and other tobacco products, at least in part to promote public health by reducing tobacco use.

State Excise Taxes on Alcoholic Beverages

Compared with studies based on aggregated data (mainly State alcohol-beverage sales), studies using individual self-reported alcohol consumption generally found that the demand for alcohol was more responsive to price (Chaloupka et al. 2002; Fogarty 2006; Gallet 2007; Wagenaar et al. 2009). For example, Wagenaar and colleagues (2009), on the basis of an analysis of 112 studies using various types of data, indicated that the average elasticities were −0.46 for beer, −0.69 for wine, and −0.80 for spirits. Likewise, Gallet (2007) showed that among 300 estimates, the median elasticities were −0.36, −0.70, and −0.68 for beer, wine, and spirits, respectively. However, numerous studies over the last two decades using a variety of econometric and statistical methods and different types of data have confirmed that higher prices substantially can reduce alcohol use (and abuse) and related adverse consequences even among heavier drinkers. Given the limited comparability of cost studies and the implications discussed above, we suggest that funding for future cost-of-illness studies should be tied to adhering to methodological standards, such as imputing cost categories to achieve better comparability between studies [13, 14]. Such an approach would not only further facilitate better comparability between countries but would also allow for benchmarking between countries, which is one of the major methodologies used to improve health care systems (e.g. Bennett et al. [56] for the area of non-communicable disease).

Reducing the burden from harmful use of alcohol

Furthermore, this study is the first to overcome the limitations of previous reviews (e.g. Rehm et al. and Thavorncharoensap [8, 9]) related to methodological differences in cost estimation, thus eliminating a key barrier to compare costs across studies and countries. With growing awareness of the impact of alcohol consumption on global health and an increase in international frameworks for action, the demand for global information on alcohol consumption and alcohol-attributable and alcohol-related harm, as well as related policy responses, has increased significantly. The Global Information System on Alcohol and Health (GISAH) has been developed by WHO to dynamically present data on levels and patterns of alcohol consumption, alcohol-attributable health and social consequences and policy responses at all levels. The cost of excessive alcohol use in the United States reached $249 billion in 2010, or about $2.05 per drink. Binge drinking is defined as drinking four or more alcoholic beverages per occasion for women or five or more drinks per occasion for men. Further, 2 of every 5 dollars were paid by federal, state, and local governments, demonstrating that we are all paying for excessive alcohol use.