The Economic Impact of Alcohol year cost $60 billion. Costs of alcohol abuse are Abuse and Alcoholism expected to be $136 billion a year by 1990, mostly from lost productivity and employment. Between 6 and 7 million workers are alcoholic, with an THOMAS R. BURKE undetermined loss of productivity, profits, and competitiveness of American business. Alcohol Mr. Burke is Chief of Staff, Office of the Secretary, abuse contributes to the high health care costs of Department of Health and Human Services. Tearsheet requests to Mr. Thomas R. Burke, Office of the the elderly beneficiaries of Federal health financing Secretary, Room 606G, Hubert H. Humphrey Building, Wash- programs. Heavily affected minorities include ington, DC 20201. blacks, Hispanics, and Native Americans. Society tends to treat the medical and social Synopsis ..................................... consequences of alcohol abuse, rather than its The economic effects of alcohol abuse are as causes. Although our experience with the conse- damaging to the nation as the health effects, quences of alcohol abuse is greater than that for affecting the family, the community, and persons any other drug, public concern for its prevention of all ages. Underaged drinking is interfering with and treatment is less than for other major illnesses children's development, affecting the nation's abil- or abuse of other drugs. Alcohol abuse is a ity to respond to economic challenge in the future. problem being given high priority within the De- The college aged may be the most difficult to partment in an effort to create a national agenda educate about alcohol abuse because of drinking on the issue and to try to impart a greater sense of patterns established at an early age and susceptibil- urgency about the problems. Ways are being ex- ity to advertising inducements. plored to integrate alcoholism activities into more Departmental programs. Employee assistance pro- Health care costs for families with an alcoholic grams for alcohol abuse have been established in member are twice those for families without one, about 90 percent of major companies, and Federal and up to half of all emergency room admissions employees' access to treatment is being expanded are alcohol related. Fetal alcohol syndrome is one through health insurance coverage. Collective pub- of the top three known causes of birth defects, and lic efforts are required to encourage prevention and is totally preventable. Alcohol abuse and alcohol- treatment efforts, and to begin to reduce the ism are estimated to have cost the nation $117 economic effects of alcohol abuse that the country billion in 1983, while nonalcoholic drug abuse that can no longer afford. A LCOHOL is the foremost drug of abuse in the Studies show that the consumption of alcohol United States today. The consequences of alcohol can begin very early. It is not uncommon these abuse, including the disease of alcoholism, exact a days for children to begin drinking before they far greater toll on our health and on our social have reached the age of 12 years. Elsewhere in this well-being than the abuse of any other substance. journal, medical experts attest to the harm that Because of my training as an economist, I tend to alcohol can do to young minds and bodies evaluate the economic aspect of issues. In my view, indeed, to the emotional and physical health of the effects of alcohol abuse and alcoholism are as people of any age. damaging to our nation's economy as they are to Let's look, again, at the children who are drink- our nation's health. ing, including those who are drinking wine coolers No single segment of our society is untouched by when their beverage of choice ought to be fruit this phenomenon-not the young, not the middle- juices, milk, and soft drinks. aged, not the elderly. Alcohol abuse affects the entire family; it troubles every community. Time Underage Drinking and again, we have seen how it tears at the very fabric of American life. -Children of any age-from toddlers to teenag- 564 Public Health Reports ers-should not have their minds clouded by alco- experience serious alcohol problems each year. And hol-or any other drug for that matter. should we be surprised to learn that more than 1 Our children are our hope for the future; it is out of 2 teenage deaths in auto accidents involve they who are going to keep our country strong. If the use of alcohol? we are to maintain our high wage-based economy, today's children are going to have to be prepared Direct Costs to face some of the most difficult challenges in the future. We currently compete in a tough interna- In 1983, health care costs alone for illness and tional marketplace for goods and services. That trauma related to alcohol abuse totaled $15 billion. marketplace will become even more competitive as Studies show that the average monthly health care the global market expands. As this new generation bill for families in which there is an alcoholic reaches adulthood, it will need to have more member is twice that of families without an alco- flexible skills and an increased ability to sustain holic member. It is estimated that 20 to 40 percent peak performance levels in order to roll with the of all inpatient hospital admissions and up to 50 high technology punches and to successfully com- percent of all emergency room admissions are pete in the international marketplace with countries alcohol related. On the brighter side, there is like Japan. This was not true with earlier genera- considerable evidence that treating alcohol-related tions, raised during and immediately after WW II, problems reduces expenditures for overall health when the United States was the most highly indus- care costs, not only for the alcohol abusers and trialized nation in the world, and international alcoholics, but for their families, as well. competition was virtually nonexistent. While the illness costs figures are shocking, even Another stratum of our society that concerns us sadder is the fact that alcohol abuse and alcoholism greatly lies between the high-school-age population destroy families, the very foundation of our soci- and the adult working-aged population. I refer, of ety. They work their destruction in many ways. course, to the nation's college students. I suspect Alcohol is involved in one-quarter to one-half of that they may be the most difficult group to reach all marital violence cases, in one-third of all child with the facts about alcohol abuse. They are molestation cases and in about 13 percent of child important because it is quite literally true that they abuse cases reported to police. will be tomorrow's leaders. They can be difficult to To-talk about families is to talk about pregnancy reach, or to educate, because they are at a time of and birth. Studies show that for one-half of all great change in their lives. While often viewed as teenage pregnancies, one or both parents had been adults by society, they are not always equipped, drinking alcohol at the time of conception. Drink- when they reach the minimum drinking age, to ing while pregnant makes a prospective mother make informed choices about drinking. Too often, much less likely to give birth to a healthy baby at they are easy prey for the beer, wine and liquor full term, yet many mothers-to-be continue to industries, with their slick marketing programs and drink (and smoke, unfortunately) during their preg- skillful advertising techniques, such as promotional nancies. In so doing, they are taking a real chance nights, drinking contests, and sports and club that their baby will be born with physical, mental, sponsorships. In addition they have established or behavioral abnormalities or with fetal alcohol drinking patterns and attitudes from their early syndrome. Fetal alcohol syndrome is one of the top teens which may be difficult to extinguish. three known causes of birth defects in the United In this connection, athletic participation is an States today, and the only one that is totally important part of growing up for millions of young preventable. men and women in this country. But 50 percent of all high school coaches surveyed in a recent USA Indirect Costs Today poll said that alcohol use by their young athletes is very serious and getting worse. The most We have looked at some of the direct costs of often cited causes of the problem were social alcoholism and alcohol abuse, with particular refer- acceptance of alcohol, a glut of TV advertising, ence to children and young people. Many experts and the ease with which alcohol can be purchased. say that the direct costs pale when compared to the Drinking is made to seem like a "glamorous and indirect effects and costs to society. Consider the grownup thing to do," one coach remarked. use and abuse of alcohol in the working-aged It is small wonder, when y6u stop to think about population, where the costs are enormous but more it, that some 4.6 million adolescents in America difficult to break out. November-December 1988, Vol. 103, No. 6 565 treatment of these and other illnesses, the combina- tion of alcohol and medication can render the medication ineffective or lethal. Alcohol abuse and alcoholism hit hard in the elderly segment of the population, contributing to extraordinarily high health care expenditures. These costs are paid by you and by me and by every other taxpayer in the United States through Federal health financing programs such as Medicare and Medicaid. Suffice it to say that the drain on the Federal Treasury for these and other government financing mechanisms, such as funds for the home- It was estimated in 1983 that alcohol abuse and less and family support programs, is enormous.