The Most Costly Drug of All - Alcohol and Its Consequences

Here's to alcohol: the cause of, and answer to, all of life's problems.
The Simpsons

Chronic alcoholics often bleed to death. Their liver gets so fibrotic that it blocks blood flow to the heart. The blood backs up into the esophagus, which bleeds. When the patients came to the emergency room, the Interventional Radiologist (me) was called in to do a TIPS procedure, a complex and difficult operation to relieve the pressure. If it works, the patient might live long enough to get a liver transplant, provided they can find a donor. All of this work and expense to fix a preventable disease, it is enough to make you stop drinking (or start).

Alcohol abuse causes about 100,000 avoidable deaths in the USA each year, ranking third behind tobacco and obesity, but is the most costly to treat. In addition to healthcare costs, the accidents, violence, missed work, depression, suicide, child abuse and other associated problems have been estimated by the world health organization to be between 2-6% of a countries GDP.(at least $280 billion dollars in the USA).

Alcohol and modern man are remarkably intertwined. The invention of Beer, by killing human waste contaminates in the water, allowed people to live together in cities. Wine is mentioned frequently in the bible and ancient literature. Production of alcohol has changed agriculture, shaped nations, and caused wars. Alcohol in its myriad forms is available on every USA street corner and store. It is such a integral part of our social fabric that life without it is inconceivable for many.

The health impact of alcohol abuse are legion. These are some statistics as quoted from 2000, (dollar numbers in 2010 are probably doubled due to inflation)

1. Twenty-five to forty percent of all patients in U.S. general hospital beds (not in maternity or intensive care) are being treated for complications of alcohol-related problems.
2. Annual health care expenditures for alcohol-related problems amount to $22.5 billion. The total cost of alcohol problems is $175.9 billion a year (compared to $114.2 billion for other drug problems and $137 billion for smoking).
3. In comparison to moderate and non-drinkers, individuals with a history of heavy drinking have higher health care costs.
4. Untreated alcohol problems waste an estimated $184.6 billion dollars per year in health care, business and criminal justice costs, and cause more than 100,000 deaths.
5. Health care costs related to alcohol abuse are not limited to the user. Children of alcoholics who are admitted to the hospital average 62 percent more hospital days and 29 percent longer stays.
6. Alcohol use by underage drinkers results in $3.7 billion a year in medical care costs due to traffic crashes, violent crime, suicide attempts and other related consequences. The total annual cost of alcohol use by underage youth is $52.8 billion.
7. Alcohol-related car crashes are the number one killer of teens. Alcohol use is also associated with homicides, suicides, and drownings-the next three leading causes of death among youth.
8. Alcohol is the drug most frequently used by 12 to 17 year-olds-and the one that causes the most negative health consequences. More than 4 million adolescents under the legal drinking age consume alcohol in any given month.

For an estimate of the costs that alcohol problems may be causing your workplace, and suggestions on what a company can do to identify and treat costly alcohol problems, go to the Alcohol Cost Calculator: http://www.alcoholcostcalculator.org.

One difference between alcohol and smoking and obesity is that alcohol causes short term problems in addition to chronic disease. Intoxication and the impairment it causes, negatively impacts the highways, workplace and household.

Perhaps because of the experience with Prohibition, and the ubiquity of alcohol, there was surprisingly little discussion in the healthcare bill about alcohol abuse. Reducing the consequences of alcohol might be the single most effective way to reduce healthcare costs.

Present programs are not very effective. Behavior programs (such as 12 step) have a 95% recidivism rate. Education programs to prevent teenage drinking have not been proven effective. Pharmacological intervention hasn't been effective, and is falling out of favor.

It appears to me that much of the money and research devoted to terminal alcohol problems, might be better spent on biochemical manipulation of the alcohol experience. If some progress could be made in reducing alcohol addiction, or preventing the long term effects, huge amounts of money might be saved. The immense amount of effort directed at the terminal stages of alcoholism compared with the inadequate efforts to prevent the problems in the first place reflect the many ironies of American Healthcare policy.