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Preliminary Estimates of Costs of Substance Abuse in CA and Savings
from Prevention
Ted R Miller, PhD
Principal Research Scientist
Pacific Institute for Research & Evaluation
240-441-2890 (cell)
Why Study Costs?Single Compact Metric
• Problem size & risk assessment• Priority setting & resource allocation • Performance comparison• Program evaluation • Advocacy
Risk Assessment: Cost of Violence (All Ages)
ETOH Only28%
ETOH & Drugs14%
Drugs Only5%
None53%
Cost of Youth Crime
None30%
ETOH Only16%
ETOH&Drug40%
DrugOnly14%
These Figures Are Based on Perpetrator Substance Use
40% of Medically Treated Assault Victims Also Are BAC-Positive
Victimization Is 7-10 Times As Likely When Someone Is Alcohol-Positive As When (S)he Is Sober
Priority-setting: BCRs for School-Based Programs (T=tobacco, V=Violence,
C=Cocaine)
PROGRAM Cost/ Kid
MJ redux
Alc redux
BCR
All Stars T $170 6% 7% 37
Keepin’ It Real T $160 5% 11% 29
LifeSkills TrainingTC $270 3% 1% 25
Project Alert C $120 4% 0% 9Project TND C $220 0% 2% 8STARS for Families $150 4% 0% 7
Benefits of Prevention Are Reductions in the Costs of
Substance Abuse & its Associated Harms
$4,393 - $2,769
$2,694 - $2,440
$2,040 - $1,802
$2,437 - $2,112
$1,783 - $679
Performance Comparison: Costs of Underage Drinking per Youth Ages 14-20
Evaluation: 21 Minimum Drinking Age
Reduces % of youth who drink & binge Raises age of initiation which lowers
the risk of alcoholism in adulthood Reduces youth DWI deaths by 19% Reduces alcohol-involved youth
suicides by 27%
Confuses college presidents
21 Minimum Drinking Age Costs $230/Youth in CA & Saves $670
Medical Work & CJ Q(life)
$40
$220
$410
You are the Governor of CA
37 M residents 233K deaths in 2010
Can I convince you to continue my $2 M program to prevent alcohol-related injuries
We did a thorough evaluation. The results are highly significant statistically. Our program reduced deaths and hospital admissions due to alcohol-related injury by
1% !!!!
Our program prevented 50 deaths and 400 hospital admissions last year.
Our $2 M program saved CA taxpayers $70 M in medical payments and work losses last year. That’s $1900 per CA resident.
Those #s Are In Proportion
Underage Drinking: The Industry Profits as the Public Pays
Underage Drinking Is Big Business in CA, Ages 14-18
Lifetime b4 Age 13 Past 30 Days
Binge 30 Days
55%
18%31%
20%
Really Big Business
1,372,000 underage customers in CA in 2009
Annual alcohol sales per kid who drank illegally = $2,445
Legal Drinker Underage
1.6
4.4
Underage Drinkers Are Great CustomersDaily Drinks Per Drinker in CA
Legal Drinker Underage
49%
82%
Booze Consumed When BAC Will Be > .08
The alcohol industry denies it markets to kids
But the signs are everywhere
Are alcopops for the martini crowd or the beer bellies?
What age group do Budweiser frogs & clever dogs target?
Lizards?
“They might as well rename it "Hello, Creepy," because that's exactly how you'll feel purchasing Hello Kitty wine, from the moment you ask the sales clerk where to find it, right through to the cash register ring-up, where they encircle the neck of your bottle with a pendant suitable for a six-year-old. A pleasant cherry-berry scent, carbonation on my tongue, a bit of sweet-ness, a lingering floral aftertaste reminiscent of bubble bath” www.seriouseats.com
17.5% of Alcohol in CA is Consumed by Underage Customers
Under 2117.5%
Legal82.5%
What kind of booze do kids drink?
Bingers grades 6-10, in the past month, drank
Beer Wine Spirits Beer Only
73%66%
80%
6%
47% of Alcopops Are Consumed Illegally by Underage Drinkers
Under 2147%
Legal53%
% of Drinkers Who Drank Alcopops in the Past Month
8th Grade
10th Grade
12th Grade
19-20 21-24 25-30
77%66% 66%
39% 39%30%
Primary Source of ETOH
Bought Shoulder Tap
Given It Stole Home/ Store
Other
8%
25%
41%
10%17%
Primary Source in Indiana by Grade
6 7 8 9 10 11 120%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Bought itGiven by Person >=21From FamilyShoulder TapStole from StoreAnother Kid/Took from Home
Nationally, $23.8 Billion of Booze Was Consumed by Underage Customers in 2009
Underage Booze Starbucks
$23.8B
$9.8B
In CA
Underage Sales
Industry Profits
$ to Combat
$3.35B$1.65B
$???M
A Devastating Tidal Wave of Alcohol-Related Harm Results
408 deaths in CA in 2010 7500 injured in DWI crashes 115 K violent crimes 180 K property crimes 115 K teens having risky sex 2800 teen pregnancies 1100 kids in alcohol treatment
Underage Drinking Harm in CA Cost $6.8 B in 2010
Violence55%
DWI Crashes17%
Property Crime
9%
Risky Sex 8%
Other Inj3%
Poisoning 1%
Treatment4.5%
FAS2%
Underage Drinking Harm in CA
Medical7%
Other Resource7%
Work25%
Quality of Life60%
A National Yardstick
Underage drink-ing
US Depts Justice & Education
$64B $70B
Divide by a Sensible Exposure Measure
$4960 Per Underage Customer $1810 Per Youth Ages 14-20 $3.05 Per Illegal Drink in CA
Per Illegal Underage Drink
Tangible costs
A drink Profit
$1.30$1.50
$0.75
Show a Performance ComparisonUnderage Drinking Cost/Youth
OH PA WV KY IN MI
$2,865
$1,759$2,040 $1,918
$2,194 $2,274
The Costs are for Events Caused by Alcohol
90% of alcohol-involved crashes 75% of alcohol-involved violence 54% of alcohol-involved property
crime 50% of alcohol-involved risky sex
(one eighth of all risky sex)
Usage Example: Oregon
Had consumption data by county Paid to get costs by county Worked with coalitions to understand the
problems & plan solutions Press releases: costs by county, how to solve Pushed county & state legislatures re costs Changed laws & enforcement
Treatm
ent
Harm
Red
uction
Intervention
Preven
tion
Selective/ Educational
Universal/Environ-
mental
Indicated/Behavioral
Prevention Typology
BCRs for School-Based Programs (T=tobacco, V=Violence)
PROGRAM Cost/ Child
MJ redux
Alc redux
BCR
All Stars T $230 6% 7% 30Keepin’ It Real T $210 5% 11% 24Life Skills Training T $360 3% 1% 20Project Northland T $640 7% 7% 17Project Star T $640 7% 3% 10Project Alert $190 4% 0% 8Project TND, Hi School
$290 4% 4% 6
BCRs for Youth Development Programs
PROGRAM Cost/ Kid
MJ redux
Alc redux
BCR
Family Matters T $260 ? 7% 13FamilyStrengtheningT $1400 15% 18% 11SocialCompetncPromo $570 ? 11% 8
AdolescntTransitionsT $2000 ? 14% 7
Child Development Pjt $370 4% 4.5% 6
Guiding Good Choices (Prep f/Drug-FreeYrs) V
$1100 9% (0%)
8% 5
Lower Return on Investment
Cost/Child BCRStars for Families $200 4.5Across Ages $2800 1.1SOAR $5100 1.0CASAstart $9800 0.9
Program Selection Criteria
Return on investment Aggregate benefits Affordability Local priorities & problems Appropriateness for the target population Political feasibility Government savings Immediacy of the impacts (weeks versus years) Intervention overlap Unevaluated spillover effects
Enforce- ment
Policies & Laws
Public Support - Norms
Environmental Prevention
PublicPrivate
Passive
BCRs for Environmental Interventions (costs & benefits computed comparably)
BCR
Mandatory Server Training 3
20% Alcohol Tax 8
30% Alcohol Tax 5
Reduce Outlet Density by 10% 7
Restrict Alcohol Sales Hours/Days 8
TV Alcohol Advertising Ban 8
21-Minimum Drinking Age 3
Enforce Serving Intoxicated Patrons Law 29
BCRs for Environmental Controls (costs & benefits computed comparably)
ENVIRONMENTAL CONTROL BCR
20% Alcohol Tax 8
30% Alcohol Tax 5
Mandatory Server Training 3
Enforce Serving Intoxicated Patrons Law 55
Reduce Outlet Density by 10% 8
Restrict Alcohol Sales Hours/Days 8
TV Alcohol Advertising Ban 8
BCRs for Environmental Controls & Workplace Programs
ENVIRONMENTAL CONTROLS BCR
Provisional License, 12AM Driving Curfew 7
Communities that Care youth SA coalition/pgm 15
WORKPLACE PROGRAMS
Team Awareness, Retail Workers 7
Prime Life 18
Program Selection
No one intervention will reduce most problems more than 10%-15%
Need a package of complementary interventions
DWI Deaths
Hardcore12%
Underage 2110%
M/C9%
Other69%
ALL DRIVERS% Redux
DWI Deaths BCR
Enforce SIP Laws 11% 55
Admin License Revoc 6.5% 21
.08 Max Driver BAC 7% 14
Intensive Breath Tests 15% 7
Server Training 17% 3.3
YOUTH
0-Tolerance LT 21 4% (20%) 24
Grad License/Curfew 2% (5%) 8
21 MLDA 4% (19%) 3.5
RECIDIVISTS% Redux
DWI Deaths BCR/ ROI
Ignition Interlock 7% 7
Impoundment 4% 5
Intensively Supervised Treatment
4% 4
House Arrest 3% 3
BROADER IMPACT
Child Seat Law LT 1% 38
M/C Helmet Law 2.5% 3
Primary Belt Law 10% 18
BROADER MEASURES % Redux DWI
Deaths
BCR/ ROI
Regional Trauma System 14% 2.7
Brief ETOH Intervention 6% 31
20% Tax on ETOH 4% 8
30% Tax on ETOH 6% 5
METHODS
Incidence-based costsSavings = Lifetime
consequences of the harms prevented
Societal viewpoint: everyone's costs count
Costs are estimated froma perspective Society Government Insurers Employers
How Do We Measure Lost Quality of Life?
METHODS
Quality-Adjusted Life Year (QALY)
QALYs are routinely used to evaluate the outcome of clinical trials & preventive health interventions
A QALY is a health outcome measure that assigns a value of 1 to a year of perfect health and 0 to death
Sum fraction of perfect health lost to a health problem each year
QALY = 1 - DALY
Placing a $ Value on QALY Loss is Optional
Reasons to monetize Compare health sector w/other investments Get a single comprehensive burden measure Victims generally should monetize
Reasons not to monetize Value of quality of life is hard to measure Valuing life is distasteful Avoid explaining how it is calculated
How to Monetize
Look at what people pay for safety & health
10,000 people each spend $500 on airbags Reduce risk of death by 1 in 10,000 $500 x 10,000 = $5M
Value of statistical life =work loss + QALY loss
Value of a Statistical Life Extra wages for
risky work
Highway safety Speed choice Use of safety
devices (belts, helmets)
● Demand & price Car safety features Smoke alarms Bicycle helmets Cigarettes Houses in dangerous/
polluted areas● Surveys
Crime Instead
Looks at jury awards for pain & suffering
Suits vs 3rd parties
Summary AOD in CA cost $165B in 2010 CA will be releasing costs by county Costs of AOD abuse are useful in risk
assessment, resource allocation, evaluation & advocacy
Costs can sell your programs Costs fairly weigh components of the SA
problem In communicating costs, show a yardstick,
divide by an exposure measure, compare performance
