Abstract

Background: Addiction accounts for one of the main disease groups in Europe, with relevant consequences to both individuals and society. There is therefore an increasing need to evaluate the economic consequences of addiction in order to develop appropriate policies. In this deliverable, we aim at evaluating the social costs of illegal drugs, alcohol and tobacco in the European Union, based on currently available publications.

Methods: A systematic search of relevant databases was conducted. Grey literature and previous systematic reviews were also searched. Studies reporting on social costs of illegal drugs, alcohol and tobacco were included. The methodology and the cost components, as well as cost estimates, were extracted from individual studies. To compare across studies, final costs were transformed to 2014 Euros.

Results: 42 studies reported in 40 papers met the inclusion criteria (8 for illegal drugs, 26 for alcohol and 8 for tobacco). There was a predominance of prevalence estimates and the human capital approach for the estimation of indirect costs. While there was a constant inclusion of direct costs related to treatment of substance use and comorbidities, there was a high variability for the rest of cost components. Intangibles were only included in two alcohol studies. Total costs showed also a great variability between studies for the three substances. Price per capita for the year 2014 ranged from 0.38€ to 78€ for illegal drugs, from 26€ to 1,500€ for alcohol and from 10.55 to 391€ for tobacco. A rough estimate for the total cost of addiction to the EU zone revealed it ranges between 1.2% and 3.9% of the total gross domestic product (GDP).

Conclusions: Addiction imposes a heavy economic burden to Europe. Given the high methodological heterogeneity that exists in the field, and in order to better assess this burden and to effectively develop adequate policies, methodological guidance is urgently needed.

Abstract

The last decades have seen the emergence of a strong interest from different stakeholders (policymakers, scholars, authorities) with regards to the definition of rigorous and reliable estimates of the social costs of illegal drugs, alcohol and tobacco. Credible estimates in this setting would provide relevant information related to the extent of the problems related to the use of these substances and the effectiveness of interventions aimed at reducing it. Nonetheless, few countries have attempted to estimate these costs and the estimates they generated are jeopardized by the various methodological disputes that characterize the research in this field.

The purpose of this work is to provide an overview of the indications coming from published guidelines for the estimation of the social costs of illegal drugs, alcohol and tobacco.. The methodological issues that will be presented will include the different approaches proposed by the literature and, were available, the effects of the adoption of different methods on final estimates. As a result of the systematic review, two frameworks are proposed for future research: a minimum standard and an ideal framework for performing such estimations.

This report examines the impact of economic recessions on substance use. We have performed a systematic literature review in which we aimed to  systematically identify empirical evidence of mechanisms that explain how economic recessions affect substance use. The primary aim is to describe how economic recessions affect use of illegal drugs. Because we found limited empirical evidence on the impact of economic recessions on use of illegal substances, we also examined the impact on two licit substances: tobacco and alcohol. Evidence on these two substances may give insight into mechanisms that are also relevant for illegal drugs and provide a way to cover the current gap in knowledge about illegal drugs.

In addition, we performed two smaller studies. A client reality check was undertaken to examine the perspective of illegal drug users receiving treatment in three different jurisdictions. This study focused on illegal drug use, but clients were also asked about their use of tobacco, alcohol, and new psychoactive drugs. Additionally, a regression analysis was undertaken to examine the macro-level relationships between economic recessions and deaths from substance use using routinely available data for 28 European countries. For the regression analyses, we only had data on alcohol and drugs.

This EXCEL file complements the LEADER Guidance document on estimating the social costs of illegal drug use (project deliverable 1.3), and contains examples of social cost estimations using real data, including ‘empty’ EXCEL templates, where own data can be introduced as to replicate the examples, obtaining results thanks to the automatic formulae included in each of the spreadsheets.

Illegal drug use causes many negative consequences for the whole society – referred to as the social costs of illegal drug use. Policymakers consider it necessary to apply a variety of measures in order to prevent, or at least attenuate, the negative effects of illegal drug use. However, the resources that can be allocated for this purpose are limited and priorities for their use must be established.

Although there are several guidance documents for estimating the social costs of drug use, there are many misunderstandings and a lack of general consent on how to solve methodological and practical problems arising in such estimations. The existing guidance documents often provide a good theoretical background, but they tend to be too general, and even for an experienced researcher it is difficult to apply their instructions.

The purpose of this new guidance pack is to introduce, for basic social cost components, a standard and internally coherent methodology for estimating the various consequences of illegal drug use, as well as to propose a standard way of presenting these results. It is hoped that such guidance will enable more social cost studies to be conducted in European jurisdictions and enhance data comparison between time and space of these social cost estimates. Such information will support policy makers and practitioners in continuing to advocate for evidence-based drug policy and to better determine where policy needs strengthening of additional implementation.

The LEADER Guidance Pack consists of two complementary tools: this Guidance PDF document, which introduces the reader to the topic and then presents the suggested methodology for estimating each of the social costs of illegal drug use, explaining and commenting the approach and then including practical examples illustrating each step of the estimation with the help of EXCEL screenshots; and an EXCEL file (project deliverable 1.4) containing examples of social cost estimations using real data, including ‘empty’ EXCEL templates, where own data can be introduced as to replicate the examples, obtaining results thanks to the automatic formulae included in each of the spreadsheets.