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Abstract
This paper discusses efforts to quantify the societal burden of substance abuse (illicit drugs, alcohol, and cigarette smoking) in the United States. The literature finds that the social costs of substance abuse are very high, with monetized estimates of indirect and direct costs exceeding $700 billion a year (in 2011 dollars). Despite media focus on illicit drugs, the estimates for alcohol and tobacco are each separately at least as high if not higher. Premature death and the indirect costs of productivity and crime- related losses drive the totals. For cigarettes, medical care expenditures are also substantial. The paper breaks down specific cost components and touches upon key factors to consider in estimating the damage from alcohol consumption and cigarette smoking. In its conclusion, the paper illustrates how these estimates can be used in policy formation, focusing on prevention and treatment services.
Keywords: Substance abuse, society, economics
Introduction
Substance abuse kills hundreds of thousands of people every year, and sends hundreds of thousands more to the emergency room; for illegal drugs, black market violence adds to the toll. Billions are spent on drug treatment and on treating associated medical complications, including HIV/AIDS. Substance abuse is implicated in a large proportion of child abuse and neglect cases, and is common among youth and young adults; the 2010 National Survey of Drug Use and Health (NSDUH) estimates that of youth aged 12 to 17, 25% have used tobacco, 35% have used alcohol, and 26% have used illicit drugs in their lifetime, with 43% of 18-year-olds having used marijuana at least once (1).
Common sense says the societal costs of substance abuse are large, but how large are they? Studies vary on the specific figures but all agree the costs are high. Harwood et al. produced the most frequently cited figures in the US for alcohol and drug abuse (2,3),and the Center for Disease Control and Prevention (CDC) provides a related estimate for cigarettes, which excluded cigar smoking, pipe smoking, and smokeless tobacco (4). Figure 1 shows all three adjusted to 2011 dollars, totaling over $700 billion. Throughout this paper, all dollar amounts have been inflated to 2011 dollars for ease of comparison using annual averages from the Consumer Price hidex (CPI) from the Bureau of Labor...