Transcript Slide 1

The Social and Economic Costs of
Alcohol Use in Wisconsin
D. Paul Moberg
University of Wisconsin
Population Health Institute
[email protected]
Revision:
January 12, 2009
U.S. High - Wisconsin
35%
U.S. median
U.S. Low
30%
25%
25%
20%
16%
24%
17%
15%
22%
15%
22%
14%
24%
15%
23%
16%
10%
5%
8%
7%
8%
8%
2004
2005
9%
8%
0%
2002
2003
2006
2007
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).
4.0
Gallons per capita
3.0
2.0
1.0
2.7
2.7
2.7
2.7
2.8
2.2
2.1
2.1
2.2
2.2
Wisconsin
United States
2.8
2.8
2.9
2.7
2.8
2.2
2.2
2.2
2.2
2.2
In WI this translates to 996 drinks
per drinker per year or 2.7 drinks/day
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
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.
Drinking Patterns in Wisconsin Primary Care Settings
ABST
LOWRISK
USE
48%
30%
ATRISK ABUSE DEP
USE
9%
8%
5%
Manwell, Journal of Addictive Disease, 1998
40%
33%
30%
31%
34%
34%
32%
26%
26%
15%
14%
2005
2007
28%
32%
20%
31%
30%
Wisconsin
28%
17%
US
Milwaukee
10%
0%
1997
1999
2001
2003
Source: Youth Risk Behavior Survey, Department of Public Instruction; Milwaukee Public
Schools; U.S. Centers for Disease Control and Prevention.
Percent H.S. Seniors Reporting Drinking in Past
30 Days
75
70
65
55
50
45
40
35
30
25
19
76
19
78
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
Percent
60
Year
Beer/Wine Once a Month or More
60.0%
Note: 2005– An
additional 21%
drink <monthly
% of all HS Students
50.0%
52%
40.0%
42%
30.0%
36%
35%
29%
20.0%
10.0%
0.0%
1985
DCYA-2005 Item 1j
1990
1995
Years
2000
2005






I don’t drinK
Ask someone of legal age
Older friends give to me
Get from friends own age
Take from parents
Parents give it to me
52%
11%
10%
10%
4%
4%



27% have had beer or wine in the last year
About 7% say they’re drinking monthly
When asked “where do you get alcohol”:
◦
◦
◦
◦
◦
86% say they don’t 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

Treatment and Excess Health Care
Costs

Arrests, Citations and Incarceration

Highway Crashes and Deaths

Other Societal Problems
$1,000
Charges for Drug-Related Hospitalization
Charges for Alcohol-Related Hospitalization
Millions
$800
$198
$600
$176
$185
$151
$400
$200
$127
$361
$393
2002
2003
$460
$481
2004
2005
$523
$0
2006
Source: Inpatient hospital discharge file, Wisconsin Hospital Association Information Center.
$100
$90
$82
$80
$76
$77
$78
2002
2003
2004
$78
2005
$70
Millions
$70
$67
$63
$63
$63
1997
1998
1999
$60
$50
$40
$30
$20
$10
$0
2000
2001
2006
Source: Human Services Reporting system, Division of Mental Health and Substance Abuse Services, Wisconsin Department of
Health and Family Services.
Fiscal # Pts
Year
Mean # With
Bad
BAC
2006
669
.215
85 (13%)
?
$ 0.74 m $ 3.32m
2007
741
.211
159 (22%)
?
$ 1.01m
$ 5.67m
2008
717
.223
367 (51%)
?
$ 4.69m
$ 9.70 m
Total
2,127
$ 6.44m
$ 18.7 m
Debt/Cha
rity
write-off
Total
Charges
611 (29%) $35.6m
(Subset of
1384 pts)
Charity &
Bad Debt
write-off
(Episode
Charges)
Charity &
Bad Debt
write-off
(Total pt
charges)

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)
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-2005—20% 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)
1,000
776 749 766
800
732 721 719 714 729 716
692 712
600
534 538 521 551 509
492 497 493 482 463 479
400
200
United States
Wisconsin
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 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.
BAC Level
With Prior*
DWI
No Prior*
DWI
Total
.08 or
higher
8%
92%
12,491
(22%)
.01 to .07
4%
96%
2,349
(4%)
.00
1%
99%
42,855
(74%)
Total
3%
97%
57,695
*In past 3 years

Crime

Suicides (20-37%)

◦ Sexual Assaults (up to 60%)
◦ Assaults (37-40%)
◦ Homicides and Manslaughter (49-86%)
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))

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.
◦ Access to/availability of alcohol
◦ Affordability of alcohol
◦ Attractiveness of alcohol use
◦ Acceptability of risky and
underage alcohol use
◦ And…safety is also important
*Thanks to Julia Sherman

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

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

Intervention and treatment continuum
◦ Screening and Brief Intervention (SBIRT)
◦ Treatment availability
 Engagement—LOS (treatment on demand?)
 Chronic disease model—multiple treatment episodes
 Recovery support systems and continuing care
(e.g., AA, SMART Recovery, Recovery Schools)
 Co-occurring problems