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How much does alcohol and other drug abuse cost Californians?

Use of alcohol and other drugs can create serious health, safety, and social problems. But how much do these problems cost taxpayers and individuals? How much do these problems vary from place to place? What are the relative costs of alcohol as compared to other drugs? A recent study conducted at the Prevention Research Center of Pacific Institute for Research and Evaluation was designed to answer these questions for all 58 California counties as well as 50 mid-sized cities in California.

Studies of economic and social costs related to alcohol and other drug use and abuse are usually made at state and national levels. The current study innovatively drills down to the county and city level, allowing for a more detailed understanding of how these problems vary from place to place and enabling local policy makers to assess the nature of problems in their jurisdiction.

The findings show that alcohol related problems are more common and costly than problems related to the use of other drugs. In California as a whole, alcohol misuse and use disorders cost $129 billion in 2010. That is about three times the $44 billion bill for illicit drug use. The cost for alcohol use and misuse works out to $3,450 for each California resident. The costs of these problems varied greatly from one area to another. Comparing the 58 counties, the counties with the highest rate of alcohol problems had per capita costs three times that of the counties with the lowest rate (ranging from $7,819 to $2,588). For drug related problems, the counties with the highest rate of problems had more than six times the per capita cost of counties with the lowest rate (ranging from $3,786 to $608). The variation is even greater from city to city. The highest per capita cost within a city was $10,734, 11 times higher than the city with the lowest cost for alcohol related problems. For drug related problems, the city with the highest per capita cost was $7,159, almost 19 times higher than the lowest cost city.

Impaired driving in California cost an estimated $26 billion in 2010, with crashes attributable to alcohol dominating these costs. Of the estimated $10 billion in violence costs linked to substance use, 73% were attributed to alcohol and 27% to illicit drugs. Similarly, 73% of the $127 billion in other illness and injury costs were attributed to alcohol. Conversely, 82% of the estimated $4 billion in non-violent crime costs were attributable to drugs as were 74% of the estimated $2 billion in treatment costs.

In 2010, alcohol caused or contributed to an estimated 22,281 deaths in California and drug abuse added another 5,533. Deaths (summed across the impaired driving, violence, and other mortality categories) accounted for 64% of the estimated $173 billion in substance misuse and use disorder costs in the state. Injury deaths alone including impaired driving crashes, homicides, suicides, and overdoses among others accounted for 28% of total costs. Long-term illness deaths associated with substance abuse accounted for the remaining 36%. In 2009, substance misuse and abuse in California caused or contributed to an estimated 514,000 violent crimes rapes, robberies and assaults with alcohol responsible for 350,000 and illicit drugs for 164,000.

The study emphasizes the usefulness of having more localized cost estimates. Lead study author Ted Miller stated, “We can provide cost estimates for any California county and for the 50 cities included in the study. We want to make this information available to policy makers and the public throughout the state to help them with planning and resource allocation.” Study co-author, Paul Gruenewald stated, “Our research over many years indicates the importance of the local community environment in predicting and preventing alcohol and other drug problems. This research provides an important tool to communities in California.”

The researchers based cost estimates on available data regarding the incidence of impaired driving crashes (including fatalities, injuries, and property damage), other alcohol related crimes and injuries, alcohol and drug abuse related medical conditions and costs of treatment for alcohol and other drug abuse disorders, fetal alcohol effects, child abuse and neglect related to alcohol and other drug use, and risky sex leading to sexually transmitted diseases among young people related to alcohol and drug use.

Costs for each type of alcohol and/or drug related problem included tangible costs, such as spending on medical care, property damage, public services (police, fire, etc.), adjudication, and sanctioning. Tangible costs can be direct (paid out of pocket) or indirect (e.g., the value of wages and fringe benefits not earned or the estimated cost of replacing household work not done, because people are killed, injured, or ill). Intangible costs put a value on things one cannot buy and sell -- pain, suffering, and lost quality of life.

The researchers used estimates of the incidence and prevalence of alcohol and other drug use, abuse and related problems to calculate costs in 2010 dollars for all 58 counties and a sample of 50 cities with populations between 50,000 and 500,000 persons in California. The estimates were built from archival and public-use survey data collected at state, county and city-levels over the years from 2009 to 2010.

With regard to the geographic distribution of problems and costs, the more rural northern and central areas of the state (excluding the San Francisco Bay Area) had higher per capita costs resulting from alcohol and other drug problems. The geographic distribution of costs was generally similar for alcohol and drugs. But the cost related to alcohol was uniformly greater than that for other drugs. Alcohol burden was greatest in the north central valley, more rural southern counties and Los Angeles. Costs related to illicit drug use were most substantial in the state’s northern tier and San Francisco Bay area.

Costs related to substance abuse varied considerably between cities within counties, with some city areas exhibiting far greater costs than others. Although costs related to alcohol are dominant across the board, urban areas tend to have greater costs related to illicit drug use than do rural or suburban areas.

The estimates of cost provided by this research help convey the magnitude of alcohol and other drug use problems. These assessments also can help set priorities for allocation of scarce prevention and treatment resources, compare performance of prevention and treatment efforts, and quantify returns on prevention and treatment investments.

Dr. Miller concluded, “Efficient funding of substance abuse prevention, enforcement and treatment hinges upon understanding the variation of alcohol and other drug problems from place to place. For example, our data can inform local decisions about prioritizing police enforcement of impaired driving versus drug-related crime. Because estimated costs combine data across many health and social issues, they provide an effective, comprehensible, and comprehensive measure for use in understanding how communities shape their distinctive social environments and for monitoring the effectiveness of our intervention strategies.”

The full paper, Heterogeneous Costs of Alcohol and Drug Problems Across Cities and Counties in California, by Ted R. Miller, Peter Nygaard, Andrew Gaidus, Joel W. Grube, William R. Ponicki, Bruce A. Lawrence, Ph.D., and Paul J. Gruenewald, Ph.D., , is published in the journal Alcoholism:Clinical and Experimental Research,

The Pacific Institute for Research and Evaluation is an independent, nonprofit organization merging scientific knowledge and proven practice to create solutions that improve the health, safety, and well-being of individuals, communities, and nations around the world.

For further information, contact Diane Williams, Communications Officer, Executive Services and Corporate Communications, Email: