Addictions and Recovery

The cumulative economic and emotional costs of alcoholism, drug misuse, and behavioral addictions are daunting. Here, I cite some statistics pertaining to alcohol, cocaine, nicotine, and gambling:

Alcohol

In the book Preventing Harmful Alcohol Use, https://doi.org/10.1787/6e4b4ffb-en, published in 2021, the authors of chapter 4, entitled The Health and Economic Burden of Alcohol Consumption, cite the following consequences of consuming what may appear to be a modest amount of alcohol, exceeding just 1 drink per day for women and 1.5 drinks per day for men:

1. 1.1 billion new cases of dependence, 37 million cases of injury, 12 million cases of diabetes, 24 million cases of cardiovascular disease (CVD), 5 million cases of cirrhosis and 10 million cases of cancer can be attributed to this level of alcohol consumption between 2020 and 2050. The net result is a decrease in life expectancy;
2. The premature death rate has increased, ranging from 0.5 per 100 000 population in Saudi Arabia to 50 per 100 000 population in Lithuania;
3. Health utilization has increased, accounting for about 2.4% of the total health care expenditure in OECD countries;
4. Alcohol consumption above the 1/1.5 drinks per day cap increases the expenditure associated with the treatment of CVDs, diabetes, injuries, alcohol-related cancers and cirrhosis. Incidence of other diseases that usually develop at older ages may decrease due to shortened life expectancy resulting from alcohol use. This may result in a reduction in the cost of treatment of some other conditions, such as non-alcohol-related cancers, dementia and musculoskeletal disorders (MSDs).
5. Diseases caused by alcohol consumption has caused a decrease in employment and productivity. When this effect is converted into an economic value, OECD countries lose about USD PPP 595 billion (purchasing power parity) per year. “On average, OECD countries lose USD PPP 344 per capita per year in labour-related costs, which is about 5.5 times as high as the health spending attributable to alcohol consumption above the 1/1.5 drinks per day capita.

Cocaine

In an article that appeared in the 2 February 2022 issue of Cureus, Trends of Cocaine Use and Manifestations in Hospitalized Patients: A Cross-Sectional Study,  10.7759/cureus.22090, the authors mention the following statistics pertaining to cocaine use in the United States:

1. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that in 2019, over 41 million people aged 18 years or more reported lifetime use of cocaine, and 5.4 million people reported having used cocaine in the past year. In 2017, emergency departments reported 70,237 deaths due to drug overdose, a 9.6% rate increase compared to 2016. Of these, cocaine contributed to a 32.9% increase in deaths compared to the previous year. Long-term use of cocaine adversely affects the cardiovascular, neurological, and psychological health of users It also increases pregnancy-related complications, exacerbates mental health disorders and overall mortality;
2. Out of 261.38 million admissions, 2,368,886 had cocaine use in the years 2006 to 2018. In the year 2018, the mean age was 44.86, and females were 35.09%. The trend analysis of cocaine use in hospital admissions showed an initial decrease from 2006 (424,129) to 2014 (270,790) and an increase from 2016 (355,095) to 2018 (422,481);
3. There is an increase in the prevalence cardiovascular and cerebrovascular comorbid events since 2006, including acute myocardial infarction (4.13 to 7.85%), uncomplicated hypertension (23.69% to 27.55%), hypertension urgency/emergency (5.51% to 17.33%), arrhythmias (6.49% to 12.48%), non-ischemic cardiomyopathy (0.25% to 0.5%), heart failure (7.51% to 15.13%), and peripheral vascular disease (0.8% to 3.68%) cocaine associated cerebrovascular disease (2.88% to 4.62%), hemiplegia/paraplegia (0.76% to 1.85%) and seizure (0.06% to 0.25%) has increased from 2006 with p<0.001;
4. Adjusted in-hospital mortality was higher with concomitant use of the stimulants, with an adjusted odds ratio of 1.28 (CI 1.02 -1.6, p=0.03);
5. ​There is an increase in the financial burden on healthcare and resource utilization. Specifically, adjusted total hospitalization charges increased from 2006 to 2018 (28,016 to 43,106, p<0.001) while adjusted mean LOS remained stable (5.84 days to 5.47 days, p=0.42). The total financial burden incurred due to cocaine use-related hospitalizations nearly doubled from ($10.8 billion to $19 billion, p<0.001).

Nicotine

In the fact sheet entitled “Tobacco”, published by the World Health Organization in July 2023, the following statistics are cited:

1. Tobacco kills up to half of its users.
2. Tobacco kills more than 8 million people each year, including 1.3 million non-smokers who are exposed to second-hand smoke. Regarding the lethality of second-hand smoke, it causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer, and kills around 1.3 million people prematurely every year.
3. Around 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries.
4. In 2020, 22.3% of the world’s population used tobacco: 36.7% of men and 7.8% of women.

Gambling

The UK Office for Health Improvement and Disparities cites the following statistics in The Economic and Social Cost of Harms Associated with gambling in England, published in 2023:

1. The data consistently shows that higher gambling expenditure is associated with worse financial outcomes. The analysis shows that a 10% increase in absolute gambling spend is associated with an increase in payday loan uptake by 51.5%, an increase in credit card use by 11.2%, and the likelihood of missing a mortgage payment by 97.5%;
2. In a sample of 72 participants from homeless centres in Westminster, London, investigators explored the proportion of gamblers who
3. experienced a problem with gambling before entering homelessness services. Findings showed 61.5% of at-risk gamblers and 82.4% of problem gamblers participated in gambling activities before becoming homeless;
4. Problem gamblers have an increased likelihood of suicide. The estimate of between 117 and 496 suicides associated with problem gambling or gambling disorder results in a cost of £241.1 million to £961.7 million;
5. Problem gamblers are also more likely to be affected by depression. In England, there are 69,099 people with depression associated with moderate-risk and problem gambling. This equates to £114.2 million of excess healthcare costs, which is a cost to government, and QALY losses of £393.8 million, which is a societal cost.
6. Problem drinkers are more likely to be dependent on alcohol and to misuse illicit drugs, such as cocaine. The analysis estimates 20,658 have alcohol dependence associated with harmful gambling, and of these, 2,591 receive alcohol treatment in England. This equates to £3.5 million in 2021 to 2022 prices. The analysis also estimates that 1,312 people aged 16 to 24 use illicit opiates and/or crack cocaine associated with at-risk and problem gambling in England. Of these, 628 receive community drug treatment in a given year. This equates to a cost of £1.8 million in 2021 to 2022 prices. These are financial costs to government.