Skip to Navigation

About the Alcohol Cost Calculator

Methods Used by The Center for Integrated Behavioral Health Policy to Calculate Company-Specific Business Costs of Problem Drinking

Alcohol problems are among the most common and costly health conditions affecting Americans: over 17 million adults have alcohol use disorders, either alcoholism or other, less severe, problems.1 The cost of these problems to the nation’s economy is enormous: $185 billion yearly.2 Yet, despite widespread public awareness of the scope of alcohol problems in U.S. society, research shows that business leaders and policymakers remain largely in the dark about its heavy economic costs. Many businesses have not examined the costs of undetected and untreated alcohol problems on their bottom lines.

To help sharpen understanding of the business cost of drinking, the Center for Integrated Behavioral Health Policy, an initiative based at The George Washington University Medical Center, devised a calculator that shows how alcohol-related problems generate avoidable health care costs and reduce workforce productivity. The Alcohol Cost Calculator provides concrete, industry-specific information, grounded in research, about the impact of problem drinking. The Alcohol Cost Calculator, first released for public use in April 2003, and most recently updated in November, 2009, estimates the business impact of the continuum of alcohol problems — categorized here as alcohol dependence (alcoholism) and alcohol abuse 3 — on 13 sectors of U.S. industry. It shows:

  • how common alcohol problems are in each sector
  • how many work days are lost due to alcohol problems
  • the extent of alcohol-related hospital and emergency room visits of employees and their families
  • the costs of missed work days and health care of employees and their families

This document describes in detail the methods that Ensuring Solutions uses to derive these estimates.

Acronyms

  • BLS Bureau of Labor Statistics
  • NCQA National Committee on Quality Assurance
  • NHSDA National Household Survey on Drug Abuse
  • NSDUH National Survey on Drug Use and Health
  • SAMHSA Substance Abuse and Mental Health Services Administration
  • NIAAA National Institute on Alcohol Abuse and Alcoholism

Methods

Sources of Data

The Center for Integrated Behavioral Health Policy draws upon a large government-sponsored epidemiological surveys, the National Survey on Drug Use and Health4 (NSDUH) 2004-2006 (prior to the 2002 survey, NSDUH was known as the National Household Survey on Drug Abuse [NHSDA]), to create a calculator that can provide company-specific estimates of the prevalence of substance use-related problems among employees and their families. The Substance Abuse and Mental Health Services Administration (SAMHSA) of the Department of Health and Human Services conducts the NSDUH annually. The survey generates detailed estimates of the prevalence, symptoms, and consequences of alcohol problems in the civilian, non-institutionalized U.S. population. The NSDUH uses a representative national sample, surveying people in all 50 states and the District of Columbia. Since 1999, approximately 70,000 persons age 12 and older residing in households respond each year to questions for the annual NSDUH. SAMHSA produces publicly available data annually based on a representative subgroup of about 57,000 of the NSDUH respondents. For The Alcohol Cost Calculator, The Center for Integrated Behavioral Health Policy analyzed the pooled 2004 -2006 NSDUH data. A total of 166,786 individuals were represented in the pooled 2004-2006 datasets. All respondents who met the following criteria were included in our analyses:

  • 18 years old or older
  • Employed full- or part-time
  • Reported being covered through private health insurance

Based on these criteria, a total of 56,010 individuals were included in analyses presented in the “employed track” section of the calculator. A total of 110,766 were excluded because they were unemployed, retired, adolescents, students not in the workforce, homemakers, or without private health insurance at the time of the interview.

The Center for Integrated Behavioral Health Policy used SPSS statistical software, version 15.0 (SPSS Inc., Chicago, IL) as the primary software to analyze the NSDUH. Additional analyses were conducted with the Survey Documentation and Analysis (SDA, version 3.0) computer program.5 The computer-assisted Survey Methods Program at the University of California, Berkeley developed and maintains the SDA. The data and SDA are part of the Substance Abuse and Mental Health Data Archive maintained by the Inter-University Consortium for Political and Social Research at the University of Michigan.

State Adjustments

The Center for Integrated Behavioral Health Policy computed state-level adjustments to reflect the substantial differences in alcohol use patterns from state to state. SAMHSA published state estimates of alcohol dependence and abuse for 2005 and 2006 from the NSDUH for the general population.6 The state rates published by SAMHSA were used to calculate adjustment factors by dividing the rates reported in each state, by the national prevalence. For example, the adult alcohol abuse and dependence adjustment factor for the District of Columbia was calculated by dividing the state-specific rate of alcohol abuse and dependence for adults 18 and older (10.5%) by the national adult prevalence during that same time period (7.9%) for an alcohol adjustment factor of 1.3. A similar alcohol adjustment factor was calculated for dependants by dividing the prevalence rate reported for all persons age 12 and older in the District of Columbia (9.9%) by the national prevalence rate reported during that time period (7.1%) for a alcohol adjustment factor of 1.4. These adjustment factors were then applied to prevalence rates calculated with the 2004-2006 NSDUH data in order to more accurately reflect differences in alcohol abuse and dependence rates among workers in each state.

Prevalence of Alcohol Dependence and Alcohol Abuse

The NSDUH is constructed so that alcohol (and other drug) diagnoses can be derived from survey questions.7 Among employed adults, 3.2% have alcohol dependence disorder, and 5.0% met diagnostic criteria for an alcohol abuse disorder. A total of 8.2% of working adults have an alcohol use disorder. These estimates are somewhat higher than estimates from the 1992 National Longitudinal Alcohol Epidemiology Survey, which finds a 6.7% prevalence of alcohol abuse and/or dependence among all persons with private health insurance,8 and the 7.1% prevalence of alcohol dependence and/or alcohol abuse among working adults from the NCS.9

The Center for Integrated Behavioral Health Policy calculated the prevalence of alcohol use problems in the workforces of 13 industry sectors from the NSDUH coding of respondents’ places of primary employment, using the Department of Labor standard industry classifications. The number of respondents by industry sector in the 2004 through 2006 NSDUH pooled sample ranged from 1315 in agriculture, forestry, fishing and hunting to 15,358 in the education, health and social services sector.10

Lost Work Days Estimates

The NSDUH asked respondents to recall how often they missed work due to illness and injury or skipped work in the past 30 days. The responses to these two questions are summed to measure the total number of missed workdays per month, with the total number of lost workdays capped at a maximum of 20 days per month. Mean number of missed work days are generated by industry category and multiplied by 12 to produce an estimate of total number of missed days per year.

Rates of Health Care Use

NSDUH respondents were asked how many times they had gone to a hospital emergency room in the previous 12 months, whether they had been hospitalized overnight during the previous year, and the number of nights in the hospital if they had been admitted. Mean number of emergency department visits and days in hospital are stratified by industry sector.

Cost of Absenteeism Estimates

The costs to businesses of missed work days are derived from the Bureau of Labor Statistics (BLS) Current Employment Statistics. 11 The most current average daily wages for salaried, nonsupervisory employees by industry as of July 2008 were extracted from BLS Current Employment Statistics. Where industry sectors have been combined due to limited sample size, wages were weighted according to the number of jobs in each sector and summed to derive the average wage for the combined industry sector. The cost of extra work days missed by employees with alcohol problems in each of the 13 industry sectors is computed by multiplying the estimated number of extra days missed (as computed above) by the BLS average daily wage. These cost estimates are undoubtedly conservative, since The Center for Integrated Behavioral Health Policy did not adjust for fringe benefits or for the higher salaries of supervisory and management employees.

Cost of Health Care Estimates

The Center for Integrated Behavioral Health Policy calculates the health care costs of alcohol-related problems from two sources. A per capita health care cost is derived from estimates of the economic costs of alcohol problems in the United States.12 In order to update these figures to reflect more current costs, these figures were adjusted to 2008 estimates using a similar methodology as the original reports.

For its detailed analyses of the costs of alcohol problems, The Center for Integrated Behavioral Health Policy extracts the following yearly direct health care costs related to alcohol use:

Table 1: Yearly Direct Health Care Costs
Treatment Yearly Cost
Treatment Costs $8.2 billion
Prevention and Early Intervention $1.2 billion
Treatment of Medical Consequences of Alcohol and Illicit Drug Consumption $30.6 billion
Medical Consequences of Fetal Alcohol Syndrome $5.6 billion
Insurance Administration $1.8 billion
Total: $47.3 billion

The total health care costs in 2008 are divided by the projected total U.S. population in 2008 13 to yield a per capita cost of $155. Since employers offering health insurance to their employees generally cover family members as well, the per capita health cost of alcohol and illicit drug related problems is multiplied by 2.61, the estimated average household size in the United States according to the US Census Bureau for an estimated total per-employee cost of $405.14

In addition, The Alcohol Cost Calculator estimates the costs of excess health care use. The estimated costs of extra hospital and emergency room use by persons with alcohol problems are computed by deriving the extra per capita rate of hospital and emergency room use for people with drinking problems, and then multiplying the per capita rates by the industry-specific alcohol problem prevalence rates. The resulting number of extra hospital days and emergency room visits are then multiplied by the American Hospital Association’s average daily hospital charge and by published estimates of emergency room costs.15

Additional Costs

Alcohol problems are associated with a number of hazardous and costly social consequences including driving under the influence of alcohol or drugs, getting arrested, displaying violent behavior, and many others. The Alcohol Cost Calculator illustrates the social costs of problem alcohol use by comparing prevalence rates for workers and family members with an alcohol use disorder to those without an alcohol use disorder. Prevalence rates are calculated as the percentage of respondents who had experienced an event or problem within a given time period prior to the survey (usually 12 months). The difference in prevalence rates by alcohol use disorder can then be applied to the number of individuals with an alcohol problem to derive the increase or excess that is attributed to alcohol misuse.

Results

Prevalence of Alcohol Problems by Industry Sector

Based on the analysis of the merged 2004-2006 National Survey on Drug Use and Health (NSDUH) data, most people with alcohol problems work, and the majority are full-time employees. Among adults that currently have the disease of alcoholism, 85% work (70% work full-time and 15% work part-time). Even higher workforce participation rates are found among adults who meet the diagnostic criteria for alcohol abuse: 87% work (73% work full-time and 14% work part-time). By contrast, only 74% of adults with no alcohol problems are employed (62% full-time and 12%part-time). In fact, adults with an alcohol problem are significantly more likely to work than adults without an alcohol problem.16

Male employees are twice as likely to have an alcohol problem as female employees.17 Employees with alcohol problems tend to be younger, on average than the general workforce population.18

Rates of alcohol problems vary greatly from industry to industry. Alcohol dependence rates are highest for males in arts and entertainment (6.3%) and mining and construction (5.8%), and lowest among females in agriculture (0.7%), public administration (1.1%), and information and communications (1.4%). Similar differences between male and female employees hold for other alcohol problems: alcohol abuse is concentrated among males in wholesale (9.4%), information and communications (8.6%) and arts and entertainment (8.3%), and lowest among women in agriculture (1.6%) and transportation/utilities (1.6%).

Table 2: Prevalence (in percent) of Alcohol Problems by Industry Sector
Industry Sector Number of Respondents Alcohol Dependence Alcohol Abuse
Male Female All Male Female All
Mining & Construction 4303 5.8% 4.5% 5.6% 7.5% 4.2% 7.2%
Arts and Entertainment 5687 6.3% 5.2% 5.7% 8.3% 7.2% 7.7%
Professional 5358 4.5% 3.2% 3.9% 7.2% 3.3% 5.5%
Agriculture, Forestry, Fishing, and Hunting 772 3.4% .7% 2.8% 4.9% 1.6% 4.2%
Retail Trade 7134 4.6% 2.6% 3.6% 7.9% 3.5% 5.7%
Wholesale Trade 1525 4.4% 2.9% 4.0% 9.4% 3.4% 7.6%
Finance & Real Estate 3913 4.0% 2.3% 3.0% 7.2% 5.0% 5.9%
Education, Health & Social Services 12,035 3.3% 1.6% 2.0% 4.7% 2.6% 3.1%
Other Services 2575 2.9% 1.4% 2.1% 3.7% 1.9% 2.9%
Transportation & Utilities 2386 2.6% 3.7% 2.8% 6.0% 1.6% 5.0%
Information & Communication 1332 3.5% 1.4% 2.5% 8.6% 3.4% 6.2%
Manufacturing 6140 3.4% 3.4% 3.4% 5.7% 2.8% 4.8%
Public Administration 2704 2.2% 1.1% 1.7% 5.3% 2.5% 1.7%
Other Services 2575 2.9% 1.4% 2.2% 3.9% 2.1% 3.0%
TOTAL 55,864 3.6% 2.0% 2.8% 5.9% 2.7% 4.2%

Company-specific estimates of the number of employees who are problem drinkers are computed by multiplying the NSDUH prevalence rates of alcohol abuse and dependence problems in a specified industry sector by the total number of a company's employees. When a company's state location is indicated, the company-specific estimates are adjusted for state prevalence rates of alcohol problems among workers and in the general population.

Example: For an automobile parts manufacturing company with 1,000 employees, the Calculator uses the manufacturing sector’s prevalence estimates of 8.2% with an alcohol problem (3.4% dependence and 4.8% abuse) to derive an estimate of 82 employees with an alcohol problem. These estimates only apply to the national average; the Calculator also takes into account adjusters by state.

Company-specific estimates of the number of employees' family members who are problem drinkers are computed using general population prevalence rates for alcohol dependence and alcohol abuse. The number of family members is calculated by multiplying the number of employees by 1.61 (the average number of dependants according to the US Census). This number is then multiplied by prevalence rate of alcohol problems in the general population (7.7%). No industry sector adjustment is made for employees’ family members.

Example: For the automobile parts manufacturer with 1,000 employees, the general population prevalence of alcohol use disorders of 7.7 percent for the U.S. population is multiplied by 1610 (an estimate of the number of dependents for 1000 employees) to derive an estimate of 124 problem-drinking family members. This estimate only applies for the national average; the Alcohol Cost Calculator for Business also takes into account adjusters by state.5

Workplace Absenteeism

Employees with alcohol problems miss substantially more work days each month than other employees. Employees with an alcohol problem missed an average of .91 days per month; employees without an alcohol problem missed an average of .64 days. These differences are significant and over time, add up to become quite costly as demonstrated below.

Table 3: Excess Workdays Missed Yearly (per 1000 employees) and Estimated Cost of These Missed Days
Industry Sector Alcohol Dependence Alcohol Abuse
Agriculture, Forestry, Fishing, and Hunting 1020 $90,576.00
Arts, Entertainment, Recreation 239 $20,665.01
Education, Health & Social Services 177 $26,749.79
Finance & Real Estate 96 $16,601.85
Information & Communication 167 $33,154.10
Manufacturing 216 $30,705.52
Mining & Construction 338 $61,636.61
Other Services 270 $34,214.40
Professional 331 $55,699.49
Public Administration 144 $25,430.03
Retail Trade 415 $42,989.86
Transportation & Utilities 234 $30,401.28
Wholesale 477 $77,255.94
Total 266 $38,364.19

Company-specific estimates of the number of extra work days missed are computed by calculating the average difference in number of workdays missed per month for employees with an alcohol problem versus those without an alcohol problem.    The resulting number is the total number of excess workdays that can be attributed to alcohol problems.  The actual costs of missed days experienced by any specific company will vary from these estimates due to differences in wages, sick day reimbursement policies and employee replacement costs.19

Example: To continue the example of an auto parts manufacturing company with 1,000 employees, the average number of extra missed days of employees with an alcohol problem (.22) times the prevalence of the disorder in the manufacturing sector (8.2%) yields an estimate of 18 days lost each month, or 216 days per year.

Health Care Utilization

Hospital use: Company-specific estimates of the number of excess hospital nights are computed by multiplying the percentage of persons with alcohol problems who reported any overnight hospital stay by the average number of nights for those who spent at least one night. The average per capita hospital use rate for adults with no alcohol problems is then subtracted from the rates for adults with alcohol problems.

Example: In the example of the auto parts manufacturer, the number of hospital days for persons with an alcohol use disorder (3.9 days) is multiplied by the percentage who reported an overnight stay in the hospital (6%) to generate rates of hospital days per person with an alcohol problem. The number of expected hospital days in an employed population without an alcohol problem is then calculated by multiplying the percentage of those without an alcohol problem reporting an overnight stay in the hospital (7.0%) with the average number of nights (3.8 nights) spent by patients who were hospitalized. This rate of hospital days for persons with no alcohol problem is subtracted from the rates for workers with an alcohol problem.. The difference is multiplied by the number of people with alcohol problems in the workforce to generate the estimate of the number of excess hospital days. The excess number of hospital days for family members is calculated following the same method using the prevalence rates for the entire population. The resulting estimate suggests that employees with an alcohol problem and their families would be responsible for 18 fewer hospital days.

Note Concerning Hospital Utilization for Employees with an Alcohol Use Disorder: It is important to note that the calculator estimates that employees with alcohol use disorders (abuse or dependence) have lower rates of hospitalization than employees without an alcohol use disorder. One explanation for this finding is that while employees with alcohol dependence use disorder are significantly more likely to report a hospitalization than employees without an alcohol use disorder, employees that meet the diagnostic criteria for alcohol abuse disorder are significantly less likely to report a hospitalization than employees without an alcohol use disorder. Employees that meet the diagnostic criteria for alcohol dependence also report hospital stays that are significantly longer (4.6 days) than individuals with alcohol abuse (3.2 days) and employees without an alcohol use disorder (3.8 days).

Emergency room use: Employees with alcohol problems reported greater emergency service use in the past year than workers without alcohol problems (.47 ER visits per employee with an alcohol problem versus .39 visits per employee without an alcohol problem).20 Perhaps one reason for this higher use of emergency rooms is that adult employees with alcohol problems are much more likely to drive while under the influence of alcohol or drugs. Three-quarters of employees with an alcohol problem (76%) report driving under the influence of alcohol or drugs during the past year, compared to 14% of employees without an alcohol problem. 21

Table 4: Number and Cost of Excess Emergency Room Visits Annually (per 1000 employees) – Alcohol Abuse and Dependence
Industry Sector Excess ER Visits:
Employee & Family
Cost of Excess
ER Visits
Agriculture, Forestry, Fishing, and Hunting (1) 8.7 $10,368.75
Arts, Entertain, Recreation, Accommodation, Food Svc. (11) 22.6 $26,958.74
Education, Health & Social Services (10) 14.1 $16,816.44
Finance, Insur, Real Estate, Rental & Leasing (8) 4.5 $5,339.31
Information & Communication (5) 7.2 $8,533.36
Manufacturing (3) 19.5 $23,192.62
Mining/Construction (2) 24.6 $29,366.20
Other Services (13) 13.0 $15,493.53
Professional/Scientific/Management/Admin/Waste Mngmt (9) 8.0 $9,474.89
Public Administration (12) 9.7 $11,536.72
Retail Trade (7) 16.2 $19,331.16
Transportation & Utilities (4) 20.5 $24,408.27
Wholesale Trade (6) 19.7 $23,419.07
TOTAL (US INDUSTRY AVERAGE) 14.5 $17,328.92

Company-specific estimates of the number of excess emergency room visits are computed by subtracting the average number of emergency room visits for persons with no drinking problems from the average number for persons with alcohol problems, and then multiplying the results by the estimated industry sector prevalence of alcohol problems among employees and the general population prevalence of the disorders for employees’ families. The average number of emergency room visits is generated by industry sector.

Company-specific estimates of the annual cost of health care services associated with alcohol use disorders are computed by multiplying the number of employees and their family members by the per capita cost of alcohol-related health care use. No industry sector adjustments are made.

Example:: Following the same procedure used for to estimate excess hospital use, the number of excess emergency department visits for the parts manufacturing company with 1,000 employees is 20 annually.

Social Costs

Serious Psychological Distress

The NSDUH assesses whether respondents have had serious psychological distress, formerly referred to as serious mental illness (SMI) in versions of the NSDUH prior to 2004. Nonspecific serious psychological distress is determined using a six item scale that measures how frequently respondents experienced distress symptoms during the one month in the past year when they were at their worst emotionally. The symptoms of distress include the following: feeling hopeless, feeling nervous, feeling restless or fidgety, feeling sad or depressed, feeling everything was an effort, and feeling worthless. Workers with alcohol problems are approximately two and one-half times as likely to have had serious psychological distress at some point in the previous year (20% vs. 8%). To estimate the number of workers who are likely to have had serious psychological distress, the Calculator multiplies the expected number of workers with alcohol problems by the difference between the rate of serious psychological distress among workers with alcohol problems and the rate of serious psychological distress among workers with no alcohol problems. To estimate the number of family members with serious psychological distress and alcohol problems, the Calculator multiplies the expected number of family members with alcohol problems by the difference in the general population rates of serious psychological distress of those who have alcohol problems and those who do not have alcohol problems (20% versus 8%). The Center for Integrated Behavioral Health Policy then summed the estimated excess number of workers who have psychological distress and the excess number of family members who have psychological distress.

Much of the serious psychological distress found among working people and their families is due to depression. Workers and family members with alcohol problems are almost two and a half times more likely to report a co-occurring major depressive episode in the previous 12 months than individuals without alcohol problems. Among workers, 14% of those with an alcohol problem had a co-occurring depressive disorder, and 6 percent of workers with no alcohol problem had major depression. The rates were similar among family members: among those with an alcohol problem, the prevalence of co-occurring depression was 14%; among those with no alcohol problem, the prevalence was 6%.

Smoking

The NSDUH assesses whether respondents have been addicted to nicotine within the past month. Workers with alcohol problems are about twice as likely to have nicotine dependency (18% vs. 9%). To estimate the number of workers who are likely to have a nicotine dependence (smoking) problem, the Calculator multiples the expected number of workers with alcohol problems (previously calculated by the Calculator) by the difference between the rate of nicotine dependence of workers with alcohol problems and the rate of nicotine dependence of workers without alcohol problems. To estimate the number of family members with a co-occurring nicotine and alcohol problems, the Calculator multiplies the expected number of family members with alcohol problems by the difference in the general population heavy smoking rates of those who have alcohol problems and those who do not have alcohol problems (17% vs. 7%). The Center for Integrated Behavioral Health Policy then summed the estimated number of workers who have nicotine dependence and the estimated number of family members who have nicotine dependence.

Problems with Law Enforcement

The NSDUH assesses whether respondents have been arrested and booked in the previous year. Workers with alcohol problems are two and one-half times as likely to have been arrested and booked in the past year (36% vs. 14%). To estimate the number of workers who are likely to have a problem with law enforcement in the previous year, the Calculator multiples the expected number of workers with alcohol problems by the difference between the rate of recent arrests of workers with alcohol problems and the rate of arrests in the previous year of workers without alcohol problems. To estimate the number of family members with a recent history of problems with law enforcement, the Calculator multiplies the expected number of family members with alcohol problems by the difference in the general population arrest rates of those who have alcohol problems and those who do not have alcohol problems (34% vs. 11%). The Center for Integrated Behavioral Health Policy then summed the estimated number of workers who have previous year arrest records and the estimated number of family members who have previous year arrest records.

Driving Under the Influence of Alcohol and/or Illicit Drugs

The NSDUH assesses whether respondents have driven under the influence of alcohol or other drugs in the previous year. Workers with alcohol problems are over five times as likely to have driven under the influence in the past year (76% vs. 14%). To estimate the number of workers who are likely to have a problem with driving under the influence of alcohol or drugs within the previous year, the Calculator multiples the expected number of workers with alcohol problems by the difference between the rate of driving under the influence of alcohol or drugs of workers with alcohol problems and the rate of DUI of workers without alcohol problems. To estimate the number of family members with a recent history of driving under the influence of alcohol or drugs, the Calculator multiplies the expected number of family members with alcohol problems by the difference in the DUI rates between those in the general population who have alcohol problems and those who do not have alcohol problems (45% vs. 14%). The Center for Integrated Behavioral Health Policy then summed the estimated number of workers who have recently driven under the influence of alcohol or drugs and the estimated number of family members who have recently driven under the influence of alcohol or drugs.

Violence

The NSDUH assesses whether respondents have been violent by attacking someone with the intent to cause serious bodily harm in the previous year. Workers with alcohol problems are much more likely also to report that they have attacked someone (4%) than workers without alcohol problems (.6%).To estimate the number of workers who are likely to have displayed violent behavior and who also have a n alcohol problem, the Calculator multiplies the expected number of workers with alcohol problems by the difference between the rates of workers who have reported attacking someone among those with alcohol problems compared to those without alcohol problems. To estimate the number of family members who have both an alcohol problem and who have displayed violent behavior, the Calculator multiplies the expected number of family members with alcohol problems by the difference in the general population rates of causing violence of those who have alcohol problems and those who do not have alcohol problems (4% vs. .6%). The Center for Integrated Behavioral Health Policy then summed the excess number of workers and family members who have alcohol problems as well as exhibit violent behavior.

Co-Occurring Disorders

The NSDUH results can also be used to assess the degree to which individuals with an alcohol problem meet the meet the diagnostic criteria for another substance use disorders. Workers who currently meet the diagnostic criteria for an alcohol abuse or dependence disorder are significantly more likely to meet the diagnostic criteria for illicit drug abuse or dependence (12%) than employees that workers without an alcohol problem (1%).

Domestic Violence

Past versions of the NSDUH have asked respondents to report whether they have hit, or attempted to hit, their spouse or partner in the past 12 months. Data from the last year that this question was included in the NSDUH, 2002, were used to estimate the prevalence of domestic violence cases among workers and families with and without alcohol problems. These rates were then applied to 2004-2006 alcohol prevalence rates to estimate the excess cases of domestic violence that can be attributed to alcohol problems.

To estimate the number of workers who are likely to have been a victim of domestic violence in the previous year, the Calculator multiples the expected number of workers with an alcohol problem by the difference between the rates of victimization among workers with (14%) and without alcohol problems (5%). To estimate the excess number of family members that have been victimized by domestic violence in the past 12 months the Calculator multiplies the expected number of family members with alcohol problems by the difference in the general population rates of domestic violence for those who have alcohol problems and those who do not have alcohol problems (14%vs. 4%). The Center for Integrated Behavioral Health Policy then summed the estimated number of workers who report being the victim of domestic violence and the estimated number of family members who report having been the victim of domestic violence.

Prevalence Rates of Social Problems

The following table summarizes the prevalence of the social problems described above based on the presence of alcohol problems.

Table 5: Prevalence of Social Problems
Worker
With Alcohol Use Disorder (percent) No Alcohol Use Disorder (percent) Difference (percent)
Worker
Serious Psychological Distress (past year) 20.0% 7.8% 12.2%
Major Depressive Disorder (past year) 13.8% 5.6% 8.2%
Anxiety (past year) 6.7% 3.4% 3.3%
Arrested and Booked 36.4% 13.9% 22.5%
DUI (past year) 75.5% 13.7% 61.8%
Nicotine Dependence 18.0% 8.5% 9.5%
Was a Victim of Domestic Violence 14.2% 4.5% 9.7%
Family Member
Serious Psychological Distress (past year) 20.4% 7.8% 12.6%
Major Depressive Disorder (past year) 14.1% 5.7% 8.4%
Anxiety (past year) 6.6% 3.4% 3.2%
Arrested and Booked 34.4% 11.3% 23.1%
DUI (past year) 44.7% 13.8% 30.9%
Nicotine Dependence 17.4% 7.3% 10.1%
Was a Victim of Domestic Violence 13.6% 4.3% 9.3%

Conclusion

The Alcohol Cost Calculator gives a simple estimate of the financial toll faced by individual businesses, illuminating an area with significant potential for cost reduction and improved productivity. The Center for Integrated Behavioral Health Policy has found that given the high costs imposed by alcohol problems, most employers can identify opportunities for health and productivity savings while also improving the health of employees and their families by improving access to treatment for the full spectrum of alcohol problems.

The Center for Integrated Behavioral Health Policy, November, 2009

Footnotes:

  1. U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. NATIONAL SURVEY ON DRUG USE AND HEALTH dataset. Research Triangle Park, NC: Research Triangle Institute. Ann Arbor, MI: Inter-university Consortium for Political and Social Research.
  2. Harwood, HJ. 2000. Updating Estimates of the Economic Costs of Alcohol Abuse in the United States. National Institute on Alcohol Abuse and Alcoholism. Available from the World Wide Web: http://pubs.niaaa.nih.gov/publications/economic-2000/
  3. Throughout this paper and The Alcohol Cost Calculator, the terms “alcohol use disorder” and “alcohol problems” are used interchangeably to refer to persons who meet the diagnostic criteria specified in the latest edition of the Diagnostic and Statistical Manual 4th Edition for alcohol dependence disorder and alcohol abuse disorder.
  4. U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, NATIONAL SURVEY ON DRUG USE AND HEALTH, 2004. ICPSR04373-v1. Research Triangle Park, NC. Research Triangle Institute, 2005. Ann Arbor, MI: Inter-university Consortium for Political and Social Research, 2005.
  5. Substance Abuse and Mental Health Data Archive. Available from the World Wide Web: http://sda.berkeley.edu/
  6. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. State Estimates of Substance Use from the 2005-2006 National Surveys on Drug Use and Health. OAS Series #H-33, DHHS Publication No. (SMA) 08-4311, Rockville, MD, 2008. http://www.oas.samhsa.gov/2k6state/TOC.cfm
  7. 7. The NSDUH includes a common set of questions about alcohol use that are sufficient to construct DSM IV diagnoses of alcohol dependence disorder and alcohol abuse disorder during the year prior to the interview (sampling, diagnostic algorithm, and reliability studies). Available from the World Wide Web: http://www.icpsr.umich.edu/SDA/SAMHDA/04596-0001/CODEBOOK/4596.htm.
  8. Brant, B. 1995. Variations in the Prevalence of Alcohol Use Disorder and Treatment by Insurance status. Frontlines, June 1995. The 1992 National Longitudinal Alcohol Epidemiology Survey sample consisted of 42,862 adults, 18 years of age and older, and was designed to provide detailed information about alcohol use and related disorders in the general population. In addition to diagnostic questions, the NLAES asked a broad range of background demographic questions, including work history and health care use.
  9. The NCS diagnoses were based on a modified version of the Composite International Diagnostic Interview (the UM-CIDI). The ll NCS diagnoses use DSM III-R criteria, the predecessor to the DSM-IV, which is used by the NSDUH to diagnose alcohol use disorders. The narrow DSM III-R diagnostic categories used by the NCS produced estimates of alcohol dependence disorder among working adults of 4.5% and of alcohol abuse disorder of 2.6%. The NCS is a national stratified random sample of 8098 respondents 15 to 54 years of age who were administered a detailed diagnostic interview between 2001 and 2003
  10. Detailed tables of the prevalence of problem drinking by industry, broken out by age and sex, are available from the author.
  11. July 2007 average hourly earnings of production or non-supervisory employees on private nonfarm payrolls by major industry. Available from the World Wide Web: ftp://ftp.bls.gov/pub/suppl/empsit.ceseeb16.txt
Average Hourly Wage
Agriculture, Forestry, Fishing, and Hunting $11.10
Arts, Entertain, Recreation, Accommodation, Food Svc. ( $10.79
Education, Health & Social Services $18.84
Finance, Insur, Real Estate, Rental & Leasing $21.59
Information & Communication $24.81
Manufacturing $17.73
Mining/Construction $22.80
Other Services $15.84
Professional/Scientific/Management/Admin/Waste Mngmt $21.06
Public Administration $22.13
Retail Trade $12.95
Transportation & Utilities $16.24
Wholesale Trade $20.23
TOTAL (US INDUSTRY AVERAGE) $18.05
  1. Harwood, HJ, 2000. Updating Estimates of the Economic Costs of Alcohol Abuse in the United States. National Institute on Alcohol Abuse and Alcoholism. Available from the World Wide Web: http://pubs.niaaa.nih.gov/publications/economic-2000/7. See author's note on the calculation of updates.
  2. The total estimated U.S. population used by the calculator is 305,500,000.
  3. Per capita costs were calculated by dividing the total health care costs attributed to alcohol by the total U.S. population estimated by the U.S. Census. Total health care spending of 47.3 billion dollars was divided by the estimated US population for an estimate of $155 per capita spending.
  4. The average daily hospital charge was estimated with data from HCUPnet. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, Rockville, MD. http://hcupnet.ahrq.gov/HCUPnet.jsp.
  5. Among individuals with any alcohol problem (abuse or dependence) 86% report working either full-time or part-time. Among individuals with no alcohol problem, only 74% report working either fill-time or part-time, p <.000.
  6. 5.6% of employed females meet the diagnostic criteria for alcohol abuse or dependence. 10.6% of employed males meet the diagnostic criteria for a substance use disorder. This difference is statistically significant, p <.000.
  7. 19% of workers with an alcohol problem were under 26 years of age. Only 11% of adults without a substance use disorder were under 26 years of age. This difference was significant, p <.000.
  8. These estimates are likely to err on the low side because fringe benefits, turnover and replacement costs, disability and workers' compensation costs are not included. Since the BLS average wage estimates cover only salaried, nonsupervisory and non-management employees, actual costs to companies of missed days are likely to be higher when the salaries of managers with alcohol problems are included.
  9. 2004-2006 respondents who were employed full or part time in an industry sector, by primary place of employment. This difference was statistically significant, p<.000.
  10. 2004-2006 respondents who were employed full or part time in an industry sector, by primary place of employment. This difference was statistically significant, p<.000.