• Overview
• Definition
• Incidence, prevalence and trends
• Risk factors
• Health consequences
• Costs
• Contributors

Costs

Each year alcohol misuse costs the UK about £20bn in direct and indirect costs. ¹ The direct costs include public service costs incurred in responding to the wide range of health and social problems caused by alcohol. ² Indirect costs include the loss of productivity to industry from sickness, disability, and premature death. ³

National

Much of the UK national cost estimates relating to alcohol misuse have been summarised in an interim analytical report, ¹ which was published in preparation for the National Alcohol Harm Reduction Strategy for England. ⁴ Although costs were quantified for the health service, social care, criminal justice, and industry sectors, it was not possible to estimate the total costs due to alcohol, which included human costs such as the impact of drinking on families and children, see figure 3.

NHS

Alcohol misuse has been estimated to cost the NHS about £1.7bn each year. ¹ The largest proportion is spent on specialist services, which cost £95m each year. Of this total, £24m is spent by NHS (statutory) services and £71m on voluntary sector services.

Alcohol related diseases are thought to take up one in 26 NHS bed days at a cost of about £2m and a further one in 80 NHS day cases costing about £40 000. In admissions to surgical and general medical wards, up to 30 percent of men and 15 percent of women are thought to be excessive drinkers. ⁵

Around 35 percent of attendances to accident and emergency departments and ambulance costs may be alcohol related, with a resultant cost of £0.5bn each year. Excessive drinkers are over-represented in patients using accident and emergency services, with an estimate in the UK of 40 percent of all admissions, rising to 70 percent at peak times. ⁶

Lastly, the annual primary care spend on alcohol related care is thought to be around £0.5bn. This figure, however, is likely to be an under-estimate. Patients with alcohol problems consult their general practitioners twice as often as average patients, with a wide range of common complaints such as gastrointestinal problems, hypertension, psychiatric symptoms, and injuries. The link between alcohol and the presenting complaint is often not made. Around 100 hazardous drinkers and a further 40 harmful drinkers are expected in every 2000 patients in primary care, but the primary care physician will probably be unaware of the problem in more than half of these. ⁷

Crime and disorder

Annual crime and public disorder costs have been estimated at £7.3bn. ¹ The costs of alcohol specific offences are thought to be in the realm of £30m and include crimes such as selling alcohol to underage drinkers, selling unlicensed alcohol, being drunk and disorderly, or driving under the influence of alcohol. The largest costs, however, are from offences related to alcohol, which cost a further £1.7bn each year and include criminal damage, breach of the peace and assault, often sexual assault, and domestic violence. In addition, criminal justice services spend about £1.5bn in activities geared toward preventing alcohol related criminality, such as increased policing at public events where alcohol is served.

Workplace

Workplace costs of alcohol misuse have been estimated to be £6.4bn each year. ¹ Within this figure, the costs from working days lost because of alcohol related sickness are thought to range from £11-17m, while the costs of sickness absence range from £1.2-1.7bn each year. For those in work, alcohol misuse can lead to loss of motivation, energy, and productivity at work, estimated as costing £20m. Lastly, the annual cost to industry from the premature deaths from alcohol has been estimated as £2.4bn.

International

The health costs of alcohol misuse to Europe have been estimated to be €17bn (about £11.5bn), of which €5bn is spent in treating alcohol related illnesses, preventive care, and specialist services for alcohol dependence. ⁵ The criminal justice costs are estimated to be €43bn, consisting of €15bn on policing, courts, and prisons; €12bn on prevention and insurance costs; €6bn on property damage; and €10bn on consequences of drink driving. Each year Europe is estimated to lose €9-19bn on absences from the workplace and €6-23bn on unemployment from alcohol-related problems. ⁸

Cost effective responses

In countries with a high prevalence of heavy drinking, such as the UK, the most cost effective way of reducing excessive drinking at a population level is by raising taxation on alcoholic products. The second most cost effective strategy to reduce alcohol related risk and harm is through screening and brief interventions by primary care clinicians. ⁹