Alcohol Abuse and Addiction - The Cost Of Alcohol Abuse

Living with someone who has an alcohol problem affects every member of the family. Children seem to suffer the most. The National Association for Children of Alcoholics (NACoA) estimated that there were more than twenty-eight million children of alcoholics (COAs) in the United States in 1992, including nearly eleven million under the age of eighteen. In "Children of Addicted Parents: Important Facts" (NACoA Fact Sheet, http://www.nacoa.net/pdfs/addicted.pdf), researchers suspect that children of alcoholics have a risk for alcoholism and other drug abuse two to nine times greater than that of children of nonalcoholics. They are also thought to be more likely to suffer from attention-deficit hyperactivity disorder (ADHD), behavioral problems, and anxiety disorders. They tend to score lower on tests that measure cognitive and verbal skills. COAs are also more likely to be truant, repeat grades, drop out of school, or be referred to a school counselor or psychologist.

Alcohol abuse and addiction impose a burden not only on alcoholics and their families, but also on society as a whole. Alcohol-related problems are costly in terms of medical care, treatment, rehabilitation, reduced or lost productivity, and the expenses of law enforcement.

According to the 10th Special Report to the U.S. Congress on Alcohol and Health (Washington, DC: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, June 2000), the estimated cost of alcohol abuse in 1998 was projected to have been $184.6 billion, up about 25% from $148 billion in 1992. In contrast, the cost of alcohol abuse in 1985 was $70.3 billion. In 1998 health-care costs were projected to have been $26.3 billion (14.2% of the total alcohol-related costs). The value of lost productivity due to illness ($87.6 billion), lost future earnings due to premature death ($36.4 billion), and lost productivity due to alcohol-related crime ($10 billion) together totaled an estimated $134.2 billion—nearly 73% of the total TABLE 4.8
Distinguishing differences between Type I and Type II alcoholism*
SOURCE: C. Robert Cloninger, et al., "Distinguishing Differences between Type I and Type II Alcoholism," in "Type I and Type II Alcoholism: An Update," Alcohol Health & Research World, vol. 20, no. 1, 1996

Characteristic	Type I alcoholism	Type II alcoholism
Contributing factors	Genetic and environmental	Primarily genetic
Gender distribution	Affects both men and women	Affects men more often than women
Usual age of onset	After age 25	Before age 25
Common alcohol-related problems	Loss of control over drinking; binge drinking; guilt about drinking; progressive severity of alcohol abuse	Inability to abstain from alcohol; drinking frequently associated with fighting and arrests; severity of alcohol abuse usually not progressive
Characteristic personality traits	High harm avoidance and low novelty seeking; person drinks to relieve anxiety	High novelty seeking; person drinks to induce euphoria
*The characteristics listed in this table define the type I and type II prototypes that only represent the two extremes of a continuous spectrum of manifestations of alcohol abuse.

TABLE 4.9
Profiles of Type A and Type B male and female alcoholics
SOURCE: Frances K. DelBoca and Michie N. Hesselbrock, "Profiles of Type A and Type B Male and Female Alcoholics," in "Gender and Alcoholic Subtypes," Alcohol Health and Research World, Vol. 20, no. 1, 1996

Defining characteristics of alcoholic subtypes	Type A	Type B
Risk factors for developing alcoholism
Familial alcoholisma,b	M<F	M<F
Childhood conduct disorder (e.g., behavioral problems)	M=F	M=F
Measures of personality (McAndrew Scale and MMPTc)a	M>F	M=F
Age of onset of problem drinkinga	M<F	M=F
Alcohol and other substance use
Alcohol use (number of ounces per daya)	M>F	M=F
Drinking to relieve negative moods and/or boredoma	M<F	M=F
Severity of alcohol dependence symptoms	M=F	M=F
Tranquilizer usea	M<F	M=F
Polydrug use	M=F	M=F
Chronicity and consequences of drinking
Physical conditions resulting from alcohol use (e.g., liver disease)a	M<F	M=F
Physical consequences of drinking (e.g., hangovers or tremors)a	M<F	M=F
Social consequences of drinking (e.g., jobloss or marital problems)a	M>F	M=F
Lifetime alcohol problems (e.g., arrests) (MAST)b,d	M=F	M>F
Number of years of heavy drinkinga,b	M>F	M>F
Psychiatric symptoms
Depression symptoms (e.g., sadness)a	M<F	M=F
Antisocial personality (e.g., stealing or fighting)a,b	M>F	M>F
Anxiety symptoms (e.g., nervousness)a	M<F	M=F
aStatistically significant gender differences for type A.
bStatistically significant gender differences for type B.
cMMPT=Minnesota Multiphasic Personality Test.
dMAST=Michigan Alcohol Screening Test.
Note: The <, >, and = signs how men and women compared with each other with respect to each characteristic. The findings presented are the results of a reanalysis of data presented by Babor et al., 1992.

alcohol-related costs. Other related alcohol-abuse costs were projected at $24 billion. This triennial report has been discontinued, so these figures are the most up-to-date at this writing. (See Table 4.10.)