International Guidelines for the Estimation of the Avoidable Costs of Substance Abuse

2 Social costs

2.1 The types of social costs attributable to substance abuse

The aggregate costGuidelines (Singleet al, 2003) identify the main categories of substance abuse costs. These are summarized in Table 2 below, which also indicates which categories of costs are relevant to which drugs.

Note: the symbol indicates relevant and the symbol X indicates not relevant

Table 2 - Social costs associated with substance abuse

	Alcohol	Tobacco	Illicit drugs
Tangible
1. Consequences to health and welfare system
2. Productivity consequences in the workplace and the home
3. Crime, law enforcement and criminal justice
4. Road accidents		X
5. Fires			X
6. Environment
7. Research and prevention
Intangible
8. Loss of life
9. Pain and suffering

Most substance abuse cost studies provide a greater cost disaggregation than presented in Table 2. The following is a detailed disaggregation of the tangible cost categories. This list is intended to be indicative rather than exhaustive. Where individual costs categories are not comprehensively dealt with in the original Guidelines, they are dealt with in more detail later in this report.

Tangible cost categories

• 1. Consequences to health and welfare system
• • 1.1 Medical
  • 1.2 Hospital
  • 1.3 Nursing homes
  • 1.4 Pharmaceuticals
  • 1.5 Ambulances
  • 1.6 Research and prevention
  • 1.7 Welfare administration
  
  
• 2.1 Productivity consequences in the workplace
• • 2.1.1 Reduction in paid workforce
  • 2.1.2 Absenteeism
  • 2.1.3 Reduced on-the-job productivity
    
  
  
• 2.2 Productivity consequences in the home
• • 2.2.1 Reduction in unpaid workforce
  • 2.2.2 Sickness
    
  
  
• 3. Crime, law enforcement and criminal justice
• • 3.1 Law enforcement
  • 3.2 Courts
  • 3.3 Legal charges
  • 3.4 Incarceration and corrections
  • 3.5 Violence
  • 3.6 Property damage
  • 3.7 Lost productivity of prisoners
  • 3.8 Lost productivity of criminals
  • 3.9 Insurance administration
    
  
  
• 4. Road accidents
• • 4.1 Productivity in the workplace
  • 4.2 Productivity in the home
  • 4.3 Health care
  • 4.4 Law enforcement
  • 4.5 Legal charges
  • 4.6 Incarceration
  • 4.7 Vehicle damage
  • 4.8 Insurance administration
    
  
  
• 5. Fires
• • 5.1 Productivity in the workplace
  • 5.2 Productivity in the home
  • 5.3 Health
  • 5.4 Fire services
  • 5.5 Property damage
  • 5.6 Insurance administration
    
  
  
• 6. Environment
• • 6.1 Clean up
  • 6.2 Pollution
    
  
  
• 7. Research and prevention
• • 7.1 Research
  • 7.2 Prevention

It is probable that the basis for estimating the avoidable percentage of some cost categories may be equally applicable to other cost categories. For example, the avoidable proportion of alcohol-attributable medical costs will probably also be applicable to alcohol-attributable hospital costs. However, for the purposes of systematic research, it is necessary to list all cost categories individually.

2.2 Health impacts of substance abuse

Table 3 lists all the conditions which a recent WHO international study (Ezzati et al, 2004) has concluded are causally and quantifiably linked to the abuse of alcohol, tobacco or illicit drugs. Quantifiability is very important since, if causal relationships are not quantifiable, it is not possible to estimate the costs of substance abuse or the potential benefits from appropriate anti-abuse policies. In practice, this list of quantifiable drug-attributable diseases has been steadily growing and other studies have produced different lists (see, for example, Appendix B which lists a substantially greater number of conditions which Ridolfo and Stevenson (2001), an Australian study, concluded were causally and quantifiably linked to substance abuse). There are also an increasing number of diseases for which causal relationships with substance abuse have been established but not yet quantified.

Table 3 - Drug-attributable diseases for which the WHO has estimated attributable fractions

Alcohol	GBD
Low birth weight	50
Mouth and oropharynx cancers	61
Oesophagus cancer	62
Liver cancer	65
Breast cancer	69
Other neoplasms	78
Diabetes mellitus	79
Unipolar depressive disorders	82
Epilepsy	85
Alcohol use disorder	86
Hypertensive heart disease	106
Ischaemic heart disease	107
Cerebrovascular disease	108
Cirrhosis of the liver	117
Road traffic accidents	150
Poisoning	151
Falls	152
Drowning	154
Other unintentional injuries	155
Self inflicted injuries	157
Violence	158
Other intentional injuries	160
Tobacco	GBD
Tuberculosis	3
Respiratory infections	38
Nutritional deficiencies	53
Mouth and oropharynx cancers	61
Oesophagus cancers	62
Stomach cancer	63
Colon and rectum cancers	64
Liver cancer	65
Pancreas cancer	66
Trachea, bronchus and lung cancers	67
Melanoma and other skin cancers	68
Breast cancer	69
Cervix uteri cancer	70
Corpus uteri cancer	71
Ovary cancer	72
Prostate cancer	73
Bladder cancer	74
Lymphomas and multiple myeloma	75
Leukaemia	76
Other malignant neoplasms	77
Other neoplasms	78
Diabetes mellitus	79
Endocrine disorders	80
Sense organ diseases	98
Cardiovascular diseases	104
Chronic obstructive	112
pulmonary disease
Asthma	113
Other respiratory diseases	114
Peptic ulcer disease	116
Appendicitis	118
Other digestive diseases	119
Genito-urinary diseases	120
Skin diseases	124
Musculoskeletal diseases	125
Oral conditions	143
Illicit drugs	GBD
HIV/AIDS	9
Drug use disorders	90
Unintentional injuries	149
Self inflicted injuries	157

Source: Ezzati et al (2004), volume 3 (CD-ROM)

GBD signifies Global Burden of Disease code. For the translation from GBD codes to ICD-9 and ICD-10 codes see Mathers et al (2003)