CHAPTER 4
SOCIETAL AND ECONOMIC COSTS OF ALCOHOL AND DRUG ABUSE

Required amount of time to complete: Minimum of 25 minutes

Alcohol abuse and its related problems cost society many billions of dollars each year. Estimates of the economic costs of alcohol abuse attempt to assess the monetary costs of damage that result from the misuse of alcohol. These costs include expenditures on alcohol-related problems and opportunities that are lost because of alcohol. Monetary Cost of Alcohol Abuse The fact is that although the economic cost of alcohol abuse can be estimated, it cannot be measured precisely. Nevertheless, estimates of the cost give us an idea of the dimensions of the problem. In the most recent cost study it was estimated that the cost to society of alcohol abuse was $70.3 billion. Health-Related Costs Most of the costs of alcohol abuse result from the adverse effects of alcohol consumption on health. The principal categories of health-related costs of alcohol abuse are expenditures on medical treatment (a large proportion of which is for the many medical consequences of alcohol consumption; the remainder is for treatment of alcohol abuse and dependence themselves), the lost productivity that results from workers' abuse of alcohol, and the losses to society from premature deaths that are due to alcohol problems.

Treatment Costs

Part of the health costs are from the costs of treatment in a variety of settings, including alcohol treatment facilities, nursing homes, Veterans Administration hospitals, military hospitals, Indian Health Service facilities, and the cost of doctors. As mentioned in an earlier chapter, alcohol abuse can result in a multitude of health problems.
Another part of health-related costs includes losses in productivity by workers who abuse alcohol. These costs are difficult to measure, in part because of the lack of records on goods and services that are not produced.

Premature Deaths

Another segment of health-related costs is the loss to society because of premature deaths due to alcohol abuse. It is estimated that the costs of premature deaths due to alcohol abuse are $1.4 billion dollars a year.

There is a special cost of alcohol abuse that is considered separately from the costs already mentioned here. This is the cost of fetal alcohol syndrome. Costs associated with this disease include the costs of residential care, neonatal care, and treatment for hearing loss, mental impairment, and anatomical abnormalities. It is estimated that the costs of fetal alcohol syndrome are $1.6 billion annually.

In addition to the health-related costs of alcohol abuse are costs involving the criminal justice system, social welfare administration, property losses from alcohol-related motor vehicle crashes and fires, and lost productivity of the victims of alcohol-related crime as well as individuals imprisoned as a consequence of alcohol-related crime. It is estimated that these costs are roughly $10.5 billion yearly. The staggering cost of law enforcement needed for apprehending substance abusing criminals is only a minor part of the cost of substance abuse crime to society. People who make money selling drugs do not pay taxes, therefore potential tax revenue is lost to federal, state, and local governments. Drug addicts commit acts of theft, and sometimes violence within their homes and in public involving strangers. When they are arrested, they require public defenders, court costs, and room and board in correctional facilities if they are convicted. While in correctional facilities they receive health care at the expense of taxpayers. Resources: Estimating the Economic Cost of Alcohol Abuse--A Commentary by NIAAA Director Enoch Gordis, M.D., http://alcoholism.about.com/cs/alerts/l/blnaa11.htm

The costs of alcohol impaired driving affect more people than just the driver or even the victim. It affects the entire nation's population in more and bigger ways than you might have expected.

United States Crash Facts:

In 2011, 32,367 people were killed in the estimated 5,338,000 police-reported motor vehicle traffic crashes. 2,217,000 people were injured, and there were 3,778,000 property damage collisions.

An average of 89 persons died each day in motor vehicle crashes in 2011 . This means there was on an average one death every 16 minutes.
The economic cost to the citizens of the United States as a result of motor vehicle crashes in 2000 was $230.6 billion. These costs result from medical, property damage, loss of productivity and insurance.

Resource: U.S. Department of Transportation, National Highway Traffic Safety Administration, Traffic Safety Facts 2011 , Overview, DOT-HS-811-753 , National Center for Statistics & Analysis, 400 Seventh Street, S.W., Washington, D.C. 20590, pages 1, 2

In 2011, in the United States, there were 9,878 fatalities in alcohol-related crashes. In 2011, 31 percent of fatal crashes in the United States involved alcohol. In 2011, in the United States, there was an average of one alcohol-related fatality every 53 minutes. Of the 9,878 people who died in alcohol-related crashes in 2011, 6,507 (66% ) were drivers with a Blood Alcohol Concentration (BAC) of .08 or higher. In fatal crashes in 2011, 29% of the motorcycle riders had a BAC level of .08 g/dL or higher, as compared with 21% for drivers of light trucks, 24% for passenger vehicle drivers and 1% for drivers of large trucks. Over 1.21 million drivers were arrested in the United States in 2011 for driving under the influence. This is an arrest rate of 1 for every 173 licensed drivers. Resources: U.S. Department of Transportation, National Highway Traffic Safety Administration, Traffic Safety Facts 2011 , Alcohol, DOT-HS-811-700 and Overview, DOT-HS 811-753 , National Center for Statistics & Analysis, 400 Seventh Street, S.W., Washington, D.C. 20590, pages 1, 2, http://alcoholism.about.com/cs/alerts/l/blnaa11.htm

Florida Crash Facts:

In 2011 there were 2,400 fatalities in 2,214 fatal crashes.
There were 920 alcohol-related fatalities.

Resource: Florida Department of Highway Safety and Motor Vehicles, Traffic Crash Statistics Report, 2011

RISKS TO SOBER DRIVERS FROM IMPAIRED DRIVERS:

Costs per Alcohol-Related Injury

The average alcohol-related fatality in the United States costs $3.5 million:

• $1.1 million in monetary costs
• $2.4 million in quality of life losses

The estimated cost per injured survivor of an alcohol-related crash averaged $99,000

• $49,000 in monetary costs
• $50,000 in quality of life losses

Crash costs per Mile Driven in the United States averaged:

• $5.80 per mile driven at BACs of .10 and above
• $2.50 per mile driven at BACs between .08-.09
• $0.10 per mile driven at BACs of .00

Costs per Drink

The societal costs of alcohol-related crashes in the United States averaged $1.00 per drink consumed. People other than the drinking driver paid $0.60 per drink.

Impact on Auto Insurance Rates

Alcohol-related crashes account for an estimated 18% of the $103 billion in annual U.S. auto insurance payments.

Resources: National Highway and Traffic Safety Administration. Economic Impact of Motor Vehicle Crashes 2000. Summary. Retrieved On January 28, 20003 from the World Wide Web: http://www.nhtsa.dot.gov/people/economic/econimpact2000/summary.htm, National Highway and Traffic Safety Administration. Economic Impact of Motor Vehicle Crashes 2000. State Costs. Retrieved On January 28, 20003 from the World Wide Web: http://www.nhtsa.dot.gov/people/economic/econimpact2000/state_costs.htm

National Cost of a DUI

Getting a DUI is obviously a horrible idea. What you might not realize is how expensive it is, too. It varies from situation to situation and state to state, but you can guarantee it will take a big chunk out of your paycheck. According to people who know (lawyers, police and Auto clubs), the average costs (not including any costs for lost pay, personal injuries, medical costs, vehicle damage or additional penalties for causing a crash while drinking) for a first offense drunken-driving case are: Minimum fine: $ 390 Penalty Assessment: $ 666 State Restitution Fund: $ 100 Alcohol-Abuse Education Fund: $ 50 Blood or Breath-Testing Fee: $ 37 Jail Cite-and-Release Fee: $ 10 Driving/Alcohol-Awareness School: $ 375 (16 weeks minimum) License Reissue Fee: $ 100 Attorney Fees (average): $ 2,500 Auto Insurance Increase: $ 3,600 - $6,600 (The Auto Club estimates $2,200 a year for 3 years) Total $7,828 - $10,828

Resources: Mothers Against Drunk Driving. Drinking and Driving is Very, Very Expensive!. Retrieved on February 1, 2009 from the World Wide Web: http://www.maddorangecounty.org/cost.htm

FACTS ABOUT TEEN DRIVERS:

Motor vehicle crashes are the leading cause of death for U.S. teens, accounting for more than one in three deaths in this age group. In 2011, 10 percent of all drivers involved in fatal crashes and 13 percent of all drivers involved in police-reported crashes were young drivers. Total drivers involved in police-reported crashes decreased by 2 percent to 9,390,000 in 2011 from 9,543,000 in 2010. Young drivers involved in police reported crashes decreased 7 percent for the same period from 1,315,000 to 1,229,000.

Who is most at risk?

The risk of motor vehicle crashes is higher among 16- to 19-year-olds than among any other age group. In fact, per mile driven, teen drivers ages 16 to 19 are four times more likely than older drivers to crash.

Among teen drivers, those at especially high risk for motor vehicle crashes are:

• Males: The motor vehicle death rate for male drivers and passengers ages 15 to 19 was almost two times that of their female counterparts.
• Teens driving with teen passengers: The presence of teen passengers increases the crash risk of unsupervised teen drivers. This risk increases with the number of teen passengers.
• Newly licensed teens: Crash risk is particularly high during the first year that teenagers are eligible to drive.

What factors put teen drivers at risk?

Teens are more likely than older drivers to underestimate dangerous situations or not be able to recognize hazardous situations. Teens are more likely than older drivers to speed and allow shorter headways (the distance from the front of one vehicle to the front of the next). The presence of male teenage passengers increases the likelihood of this risky driving behavior. Compared with other age groups, teens have the lowest rate of seat belt use. Male high school students (12.5%) were more likely than female students (7.8%) to rarely or never wear seat belts. At all levels of blood alcohol concentration (BAC), the risk of involvement in a motor vehicle crash is greater for teens than for older drivers. African-American students (12%) and Hispanic students (13%) were more likely than white students (10.1%) to rarely or never wear seat belts. In a national survey nearly three out of ten teens reported that, within the previous month, they had ridden with a driver who had been drinking alcohol. One in ten reported having driven after drinking alcohol within the same one-month period. Nearly three out of every four teen drivers killed in motor vehicle crashes after drinking and driving were not wearing a seat belt. Half of teen deaths from motor vehicle crashes occurred between 3 p.m. and midnight and 56% occurred on Friday, Saturday, or Sunday.

Did You Know!

• One in three 8th graders drinks alcohol.
• One in five teens binge drink.
• Only 1 in 100 parents believe his or her teen binge drinks.
• Teen alcohol use kills about 6000 people each year, more than all illegal drugs combined.
• Kids who start drinking young are seven times more likely to be in an alcohol-related crash.
• High school students who use alcohol or other substances are five times more likely to drop out of school or believe good grades are not important.
• Young adults under 21 spend $5.5 billion on alcohol each year, more than all the money spent on soft drinks, tea, milk, juice, and coffee or school materials combined.
• College students consume over 430 million gallons of alcohol per year, equal to 3,500 Olympic pools.
• Alcohol abuse is responsible for 28% of college drop-outs.
• 60% of females with a sexually transmitted disease were impaired at the time of the infection.
• The average age for the first drink is 12.8 years of age.
• 1 in 6 high school seniors use marijuana daily.
• 51% of high school students consume alcohol within any two week period. (15)

Resources: (NHTSA, 2009) Full cite: National Highway Traffic Safety Administration., Traffic Safety Facts 2011 : Young Drivers, DOT 811 744, Washington DC: National Highway Traffic Safety Administration, 2009, . http://www-nrd.nhtsa.dot.gov/Pubs/811169.PDF, (NIDA, 2008) Full cite: National Institute on Drug Abuse. ?Volume 1: Secondary School Students?, National Survey Results on Drug Use from The Monitoring the Future Study, 1975-1997. Rockville, MD: Department of Health and Human Services, 1998., http://www.madd.org/statistics/

DON’T LET THIS HAPPEN TO YOU! NEVER CONSUME ALCOHOL AND DRIVE!

THE INFLUENCE OF THE MEDIA:

The mass media annually spends a billion-and-a-half dollars on advertising for beer, wine, and spirits far exceeding expenditures for prevention and education by government or nonprofit agencies.

Attractive and youthful (but not underage) characters display enjoyment (but not intoxication). Among the benefits frequently linked to the alcohol products are social camaraderie, romance, masculinity/femininity, adventure, relaxation, and elegance.

Relatively few ads portray alcohol in hazardous contexts such as vehicle scenes, or depict negative driving consequences such & hangovers, accidents, diseases, or embarrassment. Advertising has potential for direct effects on impaired driving based on occasional content portrayals juxtaposing moving vehicles with scenes of beer drinking in TV commercials and the association of alcohol and professional racing cars, and on more subtle linkages between beer and the challenging excitement of speed and macho risk taking. Advertisements rarely warn the audience about the dangers of drinking before or during driving, which precludes learning about this risk and possibly deemphasizes the dangers of driving impaired. An audience may infer that safety is not a significant issue based on portrayals of characters consuming alcohol away from home settings without any recognition of how they will achieve safe transportation.

Advertising may also produce indirect effects that increase the likelihood of impaired driving. Many ads promote driving in bars and in outdoor locations. To the extent that drinkers are influenced to consume more alcohol in these non-home settings, the chance of driving after drinking is greater. In a survey of adolescents and young adults it was found that advertising exposure was significantly related to a drinking-driving by these individuals. Advertisers of alcohol spend more than $ 1 billion each year on targeting youth. 1/3 of all network TV episodes are set in bars, nightclubs, or restaurants where alcohol is served. 45% of TV episodes make drinking look like a positive experience, while only 10% portrayed alcohol use negatively. Alcohol was consumed in 71% of TV episodes, including 65% of the programs most popular with teens. Out of 81 G-rated animated films, nearly 50 percent showed characters using alcohol, often without consequence (34 % equated alcohol with wealth and affluence; 19 percent with sexual activity). 41 percent of teens have tried a new breed of sweet-tasting, colorfully packaged alcoholic beverages.

Resource: National Road Safety Institute, www.nationalroadsafety.org, http://210.240.189.212/ntcu9400/9402/9422/ftp/3_class/00_full_paper/AEL092325_Mass%20Communication%20Effects%20on%20Drinking%20and%20Driving_%E7%B2%98%E6%AF%93%E8%8F%AF.pdf

IMAPIRED DRIVERS AFFECT ALL OF US!

Impaired driving affects more people than just the offender. The consequences of impaired driving extend to other drivers, passengers, pedestrians, and their families. An encounter with an impaired driver can be just as difficult emotionally as it is financially and physically, if not more so. Everyone involved in an impaired driving traffic incident runs the risk of developing Post Traumatic Stress Disorder (PTSD). This disorder goes beyond depression and often includes experiencing flashbacks of the unpleasant memories of the crash scene. These memories interfere with a person's thoughts and awareness. They can happen as a person is driving or when certain images or smells remind him or her of the traumatic incident. People who are affected by PTSD usually experience the majority or all of the symptoms associated with PTSD for a month or even longer.

Deaths that occur suddenly for which family members and friends are ill-prepared can be more difficult to deal with than anticipated deaths. Sudden deaths are even more difficult to process when a person is killed violently or in a manner that could have been prevented. Losing a loved one due to another person's negligence causes strong emotions, especially anger. Sometimes, a person experiences violent thoughts or considers doing things that are out of character. As with any loss or traumatic experience, it is common for a person to go through a cycle known as the seven stages of grief.

The stages of grief include:

• Shock or disbelief.
• Denial.
• Bargaining.
• Guilt.
• Anger.
• Depression.
• Acceptance and hope.

Other common reactions to traumatic grief include:

• Feelings of isolation.
• Poor appetite.
• Sleeplessness.
• Loss of self-concern.
• Withdrawing from others.
• Loss of motivation.
• Spiritual confusion.

Resource: http://www.duifoundation.org/support/emotional/

All of us must also consider the costs to the legal system as a result of impaired driving. Taxes must pay for police officers to enforce the driving under the influence laws. Impaired driving results in costs to the court system to pay for court buildings, prosecutors, judges and court security. There are costs associated with having rescue personnel to respond to vehicle collisions as a result of impaired driving. All of society pays for the actions of impaired drivers. Of the 11.1 million victims of crimes in the United States each year, almost one in every four, or 2.7 million, report that the offender had been drinking alcohol prior to committing the crime. A recent study showed that drinking offenders committed 15% of robberies, 26% of aggravated and simple assaults and 37% of sexual assaults.

Resource: U.S. Department of Health and Human Services Public Health Services, National Institute of Health, National Institute on Alcohol Abuse and Alcoholism, 10th Special Report to the U.S. Congress, June 2000, “Drinking Over the Life Span: Issues of Biology, Behavior and Risk, pages 54 -57

PERSUADING PEOPLE NOT TO DRIVE WHEN IMPAIRED:

Although alcohol-impaired driving appears to be a single issue, it is in fact a complex problem that includes various dimensions such as alcohol abuse, underage drinking, and other social concerns. Solutions need to be equally complex and wide-ranging, demanding a comprehensive, creative, and flexible approach. It is important to view alcohol-impaired driving within the broader context of public health implications of alcohol abuse. As a result, solutions must take into account drinking patterns and groups particularly at risk.

Countermeasures vary widely, but generally aim to persuade people not to drink and drive. Initiatives can be separated into four broad groups: public education, policies, enforcement, and sanctions. Measures chosen and applied must enjoy the support of both government and the public. Without government commitment, measures aiming to prevent impaired driving can have little long-term or sustainable positive effect. Efforts to reduce the occurrence of impaired driving can be most effective and sustainable when stakeholders from various sectors and disciplines work together.

As the problem of drinking and driving affects society at large, it needs cooperation from a variety of sectors and disciplines to solve it. Government efforts through legislation, education, and enforcement can be pooled with efforts by the beverage alcohol industry, community-based organizations, and academic institutions to address the problem. The experience of numerous studies shows that collaboration among a variety of stakeholders can result in a larger and more sustainable reduction of impaired driving incidents.

Ultimately, each individual must decide for themselves if they will make the choice to drive when impaired. The choice to drive impaired however, is many times influenced by others. Peer pressure is a strong motivator and very few people do not want to be liked by others. So, there may be times when peer pressure overcomes rational thinking. Family members, other relatives, coaches, teachers and especially friends might all try to convince you to operate a motor vehicle when impaired. Some of these people may influence you to become impaired without even recognizing what they are doing.

Parent’s alcohol or drug use might encourage children to copy their parents behavior. Peer pressure by family members or friends may cause a person to start using alcohol or another drug. We have already seen how the media portrays alcohol and drug use as acceptable behavior in society.
It is important for you to have a plan in mind ahead of time when the peer pressure to become impaired begins.

Click on the ones you think might work for you.

While a simple "No, thank you" should be enough, some hosts are particularly insistent, and in some cultures, to refuse a drink outright is often seen as ungrateful and insulting. Offer a reason or excuse and defuse the tension. Just be firm and don't waver, or do anything to make it look like you might be convinced to change your mind. A firm reason, even a fabricated or humorous one, may persuade somebody that your refusal to drink is more than simple reluctance or indecision.

Here are some common excuses/reasons that work wonders:

• You're trying to lose weight, cut calories, etc.
• Your doctor advised you not to as it could interact badly with medicines, etc.
• Lent
• You're allergic
• You have a big day tomorrow
• You have an early morning appointment
• You have to drive home
• You're feeling dehydrated or under the weather
• You're recovering, or still sick and on antibiotics or other medication that can't be combined with alcohol
• You had too much the night before and can barely stand to be in the same room with it
• You're feeling nauseated. It may be something you ate.
• You're pregnant. If the person is a stranger, then they will never know you lied (unless you're a man)
• You're training for the Olympics. If your host has a sense of humor, they'll laugh (unless you look like an athlete, in which case they'll ask what you're training for). Then you can go on to tell a funny story about that time you fancied yourself a gymnast on the playground's monkey bars...
• You're a recovering alcoholic. If you are upfront about being a recovering alcoholic, you may find they are not only apologetic but also become supportive and more considerate.
• It's contrary to your religious beliefs. If you have religious or other firmly held beliefs that drinking alcohol is wrong, simply say so. If your host is unwilling to respect your religious belief, you might as well know that up front. Some people do not recommend saying anything to the effect of abiding by your beliefs, asserting that your beliefs are a personal decision and that your host and other guests might feel insulted because by saying that you're trying to do the right thing by not drinking, you're implying that they are doing the wrong thing by consuming alcohol. Worse yet, those who make this recommendation point to the possibility that a heated conversation about ethics and religion may ensue.

However, if your reason for not drinking is your religious belief, it's hard to see that lying about that is nearly as polite as it is hypocritical. You should be able to stick to your beliefs without pushing them on others. If not, you may not be ready for situations where others will be consuming alcohol.

Okay, so if none of those excuses work for you look at the list below and click on some of the ideas you think might help you to not succumb to peer pressure.

You may have found it hard to click on any of the ideas listed above and maybe you thought of some others you might even have used in the past. The important thing is to have a game plan and think about the possible consequences of an arrest, jail, loss of license, injuries and death.

BEING BUZZED IS BEING IMPAIRED!

Resources: Let’s All Work Together To Fight Drug Abuse, L. A. W. Publications, 4213 Wiley Post Road, Addison, Texas 75001, pages 4, 5, 2004). http://www.wikihow.com/Turn-Down-a-Drink, www.madd.org.

CHAPTER FOUR QUIZ