1. The Economic Impact of Addiction Lisa M. Lines, MPH University of Massachusetts Medical School March 2011
2. Definitions The economic impact of addiction is the cost associated with substance abuse and addiction as expressed in dollars Dollars spent (aka direct or resource costs) Dollars not earned (aka indirect or productivity costs) Which addictions? Alcohol Tobacco Illicit drugs & nonmedical use of pharmaceutical drugs Gambling 2
3. Which costs? The broadest estimates include all the costs associated with the following: Direct Medical care: treatment for addiction & treatment for the health consequences of addiction (eg, cirrhosis of the liver) Criminal justice: enforcement of laws, consequences of property crimes, costs of incarceration Social services (eg, foster care for children of methamphetamine addicts) The substances or behaviors themselves Indirect Excess substance abuse-related deaths (lost earnings for addicts who die prematurely) Absenteeism and lost productivity (both for substance abusers and their families) 3
4. Approaches to Calculating Cost of Illness Bottom-up Excess risks * costs associated with each consequence * prevalence Top-down Total amount spent in each category * percentage attributable to people with addictions Econometric Compare two matched cohorts, one with and one without condition – excess costs are attributed to condition 4
5. Caveats Difficult to determine whether costs incurred by an individual substance user are related to addiction per se For example, not everyone who has an alcohol-related car accident is necessarily addicted to or dependent on alcohol in a physical sense Many people have multiple addictions Somewhat misleading to simply sum up the costs associated with each addiction and call that the total economic impact of addiction; in reality, the total is likely to be less than the sum of its parts Difficult to determine causal relationships between addiction and some of the costs associated with addiction Do criminals gamble, or do gamblers become criminals? Or is there a separate causal factor that results in both gambling and crime? 5
6. Estimates of the Economic Impact of Addiction Note: total does not account for overlap between addictions 6
7. Direct and Indirect Costs of Alcohol, Tobacco, and Other Drugs by Category, 1999 Source: Miller 2008 7
11. Source: ONDCP 2010 Per Capita Costs of Drug Abuse by State, 2002 11
12. Source: ONDCP 2010 Price and Purity of Cocaine, 1981-2001 12
13. Source: ONDCP 2010 Price and Purity of Heroin, 1981-2007 13
14. Sources Grinols EL, Mustard DB. Business Profitability versus Social Profitability: Evaluating Industries with Externalities, the Case of Casinos. Managerial and Decision Economics. 2001:22(1-3);143-162. Miller TR, Hendrie D. Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis, DHHS Pub. No. (SMA) 07-4298. Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, 2008. Available at: http://store.samhsa.gov/shin/content//SMA07-4298/SMA07-4298.pdf Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004 Mar 10;291(10):1238-45. National Gambling Impact Study Commission. Final Report to Congress. 1999. Available at: http://govinfo.library.unt.edu/ngisc/reports/fullrpt.html Office of National Drug Control Policy. The Economic Costs of Drug Abuse in the United States, 1992-2002. 2004. Washington, DC: Executive Office of the President (Publication No. 207303). Available at: http://www.ncjrs.gov/ondcppubs/publications/pdf/economic_costs.pdf. Office of National Drug Control Policy. The National Drug Control Strategy: Data Supplement. 2010. Available at: http://www.whitehousedrugpolicy.gov/publications/policy/ndcs10/ndcs10_data_supl/index.html RTI International. Cost of Illness Summaries for Selected Conditions. 2006. Available at http://www.rti.org/page.cfm?objectid=CA1E1F48-8B6C-4F07-849D6A4C12CBF3C3 14
