Scottish Government

EXECUTIVE SUMMARY

E.1 Although alcohol is widely recognised as a major generator of employment and income from exports in Scotland, a considerable (and increasing) amount of harm is associated with its misuse. The effects of this misuse are wide, and generate substantial costs not only for the health service, but also for criminal justice, communities, employers, the wider Scottish economy, and Scottish society as a whole.

E.2 The specific aim of this project was to derive estimates of the cost of alcohol misuse in Scotland for 2007. Several estimates have been made of these costs during the 2000s, with a number of elements of the latter studies being updates of the findings of the original study published by the Scottish Executive in 2001. The objectives required to achieve this aim include:

• Reviewing the existing literature and approaches used in other costing studies, particularly those related to alcohol misuse;
• Identifying new research studies or data that will enable more robust estimates of the costs of alcohol misuse to be derived;
• Deriving estimates of the economic and social costs associated with alcohol.

E.3 Literature searches were undertaken to identify the key features of generic cost-of-illness ( COI) studies. Recent developments in studies of the costs of substance misuse (including alcohol misuse) have included the development of international guidelines for undertaking such studies (to promote consistency), increased interest in identifying avoidable costs, and the importance of performing sensitivity analysis. In addition, the findings and methodology of a review of the effects of alcohol pricing and promotion comprising a systematic literature review and some modelling were included. Literature searches were also undertaken to identify the most recent relevant data on activity (where available) and unit costs for inclusion in the analysis, including information on alcohol-attributable fractions for health-related and other outcomes ( e.g. crime) influenced by alcohol misuse.

E.4 The total number of hazardous adult drinkers ( i.e. aged 16+ years) in Scotland in 2007 - defined for males as drinking over 21 units per week and for females as drinking over 14 units per week - is estimated to be about 1,047,000. This number comprises about 605,000 males and 442,000 females and displays a steep downward age gradient for both sexes. The number of harmful adult drinkers - defined for males as over 50 units per week and for females as over 35 units per week - is estimated to be about 230,000. This number comprises about 141,000 males and 88,000 females and also displays a steep downward age gradient for both sexes. However, it should be noted that estimating numbers of drinkers and people who misuse alcohol is hampered by a lack of consistent national data and a tendency for those completing surveys that ask questions about alcohol consumption to under-report the extent of their drinking.

E.5 Most cost-of-illness studies include the direct costs associated with the use of services such as health care, social services and crime, and indirect costs such as the economy's lost productive capacity due to premature deaths. However, such studies frequently avoid estimating the intangible costs ( e.g. pain, grief and suffering) associated with alcohol misuse due to methodological concerns. This study includes estimates of the relevant direct, indirect and intangible costs associated with alcohol misuse. These costs are considered to fall into the following categories:

• Health care;
• Social care;
• Crime;
• Productive capacity of the Scottish economy;
• Wider social costs.

E.6 It is important to note that comparisons between countries and over time within a specific country should be avoided. This is partly because countries tend to manage and/or fund their alcohol services differently and also because information from research studies and other data availability tend to improve over time, resulting in increasingly sophisticated studies.

E.7 The estimated societal costs for Scotland in 2007 due to alcohol misuse are summarised in Table E.1. It is important to recognise the levels of uncertainty around many of the generated costs and the fact that this has led to values that should only be considered as indicative. Where possible, two cost figures have been displayed. The first figure is based on assumptions that generate the lowest cost estimate and the second figure is based on assumptions that generate the highest cost estimate.

Table E.1: Estimated societal costs of alcohol misuse in Scotland for 2007

E.8 In conclusion, alcohol misuse imposes a substantial burden on Scottish society, costing between about £2,476.6 million and £4,635.4 million per year at 2007/08 prices, with a mid-point of £3,555.7. Based on the mid-point of this range, 7.5% of costs are due to health service expenditure, 6.5% to social work services, 20.4% to crime, 24.3% to productive capacity, and 41.2% to wider social costs. In terms of the statutory agencies, alcohol misuse imposes the greatest burden on the health care system, followed by social care services.