Economic Costs of Excessive Alcohol Consumption in the U.S., 2006

Ellen E. Bouchery, MS, Henrick J. Harwood, Jeffrey J. Sacks, MD, MPH, Carol J. Simon, PhD, Robert D. Brewer, MD, MSPH

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.

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. Evidencebased 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, making it the third-leading preventable cause of death in this country.

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 analysis estimated the 1992 economic cost of alcohol abuse at $148 billion; a 1998 update put the figure at $184.6 billion. Since then, there have been no comprehensive national estimates of the costs of excessive alcohol consumption. 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.

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. The cost associated with binge drinking was $170.7 billion, underage drinking $27.0 billion, drinking during pregnancy $5.2 billion, and crime $73.3 billion.

Who Bears the Cost
Overall, $94.2 billion (42.1%) of the total economic cost of excessive alcohol use was borne by government, including federal, state, and local government agencies, while almost as much $92.9 billion (41.5%) was borne by excessive drinkers and their family members.

By cost category, the excessive drinker and their household bore 10.3% of the $24.6 billion in total healthcare expenditures related to excessive alcohol consumption. In contrast, government entities bore most (60.9%) of these costs, which is larger than the proportion of total healthcare spending that is covered by government (46.1%).18 In contrast, slightly more than half (54.6%) of productivity losses were borne by the excessive drinker and their household; 35.1% by government; and the remainder by others in society.

Costs per Alcoholic Drink
According to the NIAAA, 550,761,000 gallons of ethanol in the form of 7,538,026,000 total gallons of beer, wine, and spirits were consumed in the U.S. in 2006, or 117.4 billion standard drinks divided by the grams of ethanol in a standard drink.Thus, the total economic cost of excessive alcohol use in 2006 was about $1.90 per standard drink. Considering the $94.196 billion paid by government for excessive alcohol consumption, this government expense equated to about $0.80 per standard drink consumed in 2006.

Although the $223.5 billion figure is the best currently available estimate of the cost of excessive drinking for 2006, the authors believe it is a substantial underestimate.