D. Paul Moberg

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The Social and Economic Costs of Alcohol Use in
Wisconsin

• D. Paul Moberg
• University of Wisconsin
• Population Health Institute
• dpmoberg_at_wisc.edu
• Revision
• January 12, 2009

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Adult binge drinking prevalence Range of state
estimates Low, high, and United States median,
2002-2006
Source Behavioral Risk Factor Surveillance
System, Centers for Disease Control and
Prevention. Note Change in threshold for
women began in 2006 (4 drinks as of 2006).
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Per capita alcohol consumption, in gallons,
Wisconsin and the United States, 1996-2005
In WI this translates to 996 drinks per drinker
per year or 2.7 drinks/day
Source Per capital ethanol consumption for
states, Census regions, and the United States,
1970-2005. National Institute on Alcohol Abuse
and Alcoholism, National Institutes of Health,
U.S. Department of Health and Human
Services. Note. Per capita consumption is
gallons of ethanol consumed per person, based on
population age 14 and older.
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Magnitude of the Problem Among Adults
Drinking Patterns in Wisconsin Primary Care
Settings
LOW-RISKUSE
AT-RISKUSE
ABST
ABUSE
DEP
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8
9
48
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Manwell, Journal of Addictive Disease, 1998
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Prevalence of Binge Drinking among High School
Students Wisconsin, Milwaukee Public Schools and
the United States
Source Youth Risk Behavior Survey,
Department of Public Instruction Milwaukee
Public Schools U.S. Centers for Disease Control
and Prevention.
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Dane County High School Alcohol Use (Dane County
9th-12th Grade)
Note 2005 An additional 21 drink ltmonthly
DCYA-2005 Item 1j
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Usual Source of AlcoholDane County HS Students
2005

• I dont drinK 52
• Ask someone of legal age 11
• Older friends give to me 10
• Get from friends own age 10
• Take from parents 4
• Parents give it to me 4

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Middle School Alcohol Use (Dane County 2005)

• 27 have had beer or wine in the last year
• About 7 say theyre drinking monthly
• When asked where do you get alcohol
• 86 say they dont drink
• 3 take it from parents w/out parent knowing
• 3 say parents give it to them
• 2 friends own age
• 2 older friends

DCYA-2005 Items 1e-10e
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CONSEQUENCES of ALCOHOL USE

• Treatment and Excess Health Care Costs
• Arrests, Citations and Incarceration
• Highway Crashes and Deaths
• Other Societal Problems

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Total charges for drug- and alcohol-related
hospitalizations, in millions, Wisconsin,
2002-2006
Source Inpatient hospital discharge file,
Wisconsin Hospital Association Information
Center.
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Public funds expended for alcohol and other drug
abuse treatment, Wisconsin, 1997-2006
Source Human Services Reporting system,
Division of Mental Health and Substance Abuse
Services, Wisconsin Department of Health and
Family Services.
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Alcohol Impaired (BAC gt .08) Patients Impact
on UWHC
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Costs of Underage Drinking

• National Estimate 61.9 Billion/year
• WI estimate 1.16 Billion/year
• Underage Drinking--16 or more of all alcohol
  sales
• Costs include
• 5.4 B medical costs,
• 14.9 B work and other resource loss,
• 41.6 B lost quality of life
• These costs primarily due to alcohol attributable
  violence and traffic crashes.
• Ignoring quality of life, cost is still about
  1/drink in societal harm
• (Miller et al., JSA, 2005)

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OWI and Highway Fatalities

• WI is highest in self-reported past year drunk
  driving 26.4 (vs. 15.1 nationally) (NSDUH)
• Slightly less than 3 of these drivers receive an
  OWI
• Dane County HS Seniors-200520 drove after
  drinking in past 30 days.
• Fatal crashes in 2007 with an alcohol-impaired
  driver
• 313 deaths in WI (41 of all fatal crashes)
• 13,000 deaths in US (32 of all fatal crashes)

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Ice Cold Miller with your Fill Up?
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Rate of arrests (adult and juvenile) for
operating while under the influence (OWI) per
100,000 population, Wisconsin and the United
States, 1996-2006
Sources Crimes and Arrests in Wisconsin,
Wisconsin Office of Justice Assistance Crime in
the United States, U.S. Department of Justice,
Federal Bureau of Investigation, Criminal Justice
Information Services Division.
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Drivers in Fatal CrashesUS, 2006 (NHTSA, 2008)
In past 3 years
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Other Societal Costs (with estimated percent
related to alcohol as an indirect cause)

• Crime
• Sexual Assaults (up to 60)
• Assaults (37-40)
• Homicides and Manslaughter (49-86)
• Suicides (20-37)
• Incarceration
• 65 of adult prisoners have alcohol/drug problem
  
• 67 of Juveniles in state corrections have
  alcohol/drug problem (41 alc)
• Falls (44)
• Drowning (69)
• Domestic Violence
• Fires (26)
• Lost productivity
• FASD and ARND (100)
• Unintended pregnancy and STDs
• (Source Moore and Gerstein, 1982 Chesson et
  al., 2000 Winters et al.,2003 Rooney
  Hargarten, 2007))

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Summary

• Wisconsin leads the nation in rates of alcohol
  use and many alcohol problem indicators, and has
  for quite some time.
• Very high monetary and social costs, especially
  for youth.
• Monetary and social benefits also do accrue
• In the long run (20 years), several key
  indicators for youth and adults improved both in
  WI and nationally.
• The problem is not limited to the individual
  alcoholic or the repeat OWI offender, but
  overall risky patterns of consumption in at least
  a quarter of the population.

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Solutions Five As of Alcohol Control

• Access to/availability of alcohol
• Affordability of alcohol
• Attractiveness of alcohol use
• Acceptability of risky and underage alcohol use
• Andsafety is also important
• Thanks to Julia Sherman

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Evidence-Based Program and Policy Solutions

• Environmental Approaches to Prevention
• Cost of alcohol
• Alcohol taxes
• Drink specials
• Access/availability
• retail outlets, hours, density
• Social availability
• Advertising and promotion restrictions
• Transportation and OWI Policy
• Increase perceived risk of OWI arrest
• Graduated licensing
• Promoting safety (server training, ride programs,
  dose-effects education)
• SPF-SIG

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Evidence-Based Program and Policy Solutions
(continued)

• Educational Interventions
• Increase perceived harm
• Education and media approaches
• Press coverage of alc-involved incidents?
• Social/Peer/Community Norm Change
• Life Skills approaches
• Family strengthening and parent skills training
  programs

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Evidence-Based Program and Policy Solutions
(continued)

• Intervention and treatment continuum
• Screening and Brief Intervention (SBIRT)
• Treatment availability
• EngagementLOS (treatment on demand?)
• Chronic disease modelmultiple treatment episodes
• Recovery support systems and continuing care
• (e.g., AA, SMART Recovery, Recovery Schools)
• Co-occurring problems

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