Key Points

• Annual alcoholism-identified health costs are $246 billion.

• Alcoholic persons are heavy users of health care.

• Primary care screening is inadequate for alcoholic patients.

Alcoholism is a chronic and pervasive medical disorder that adds enormous cost to the U.S. health care system. Alcohol abuse and dependency are among the top-three preventable causes of death. The Centers for Disease Control and Prevention (CDC, 2004) estimates that for every alcohol-attributable death, 30 years of potential life is lost, accounting for 2.3 million years of potential life lost (YPLL) and 75,000 preventable deaths per year from identified cases. The total economic costs attributed to alcohol use disorders are $246 billion, of which $218 billion is related to alcohol-related motor vehicle crashes (MVCs), violence, and premature death (Harwood et al., 1998).

Alcoholic patients use health care resources disproportionately compared with other populations. Relative to the general population, alcoholics are heavy users of emergency department (ED) services, trauma-related services, acute hospitalization, diagnostic procedures, transfusions, and psychiatric services (Whiteman et al., 2000).

Estimates of the extent of alcohol involvement in trauma include 39% of MVC fatalities (National Highway Traffic Safety Administration, 2004), 47% of homicides, 29% of suicides (Smith et al., 1999), 20% to 40% for fatal recreational injuries (Mayhew et al., 1986), and 10% to 25% for home injuries (CDC 1983; Fell and Nash, 1989). Alcohol is involved in a substantial percentage of injuries caused by falls, drowning, and burns (Howland and Hingson, 1988). More than 5% of all hospital discharges other than childbirth include at least one alcohol-related diagnosis (Chen et al., 2005).

Cirrhosis of the liver continues to be largely attributable to alcohol abuse, with estimates of 60% to 90% of cirrhosis deaths (Johannes et al., 1987). Comorbidity with hepatitis C is frequently a factor in many of these alcoholic cirrhosis-related deaths. Hospitalizations for acute pancreatitis are frequently associated with alcohol dependency. Psychiatric comorbidity is common in the alcoholic population, especially depression and suicide. These sequelae have major implications for managed care organizations and federal and local payers alike. However, screening for alcoholism in primary care and emergency settings is not universal. The recent prospective data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) have provided annual incidence rates for DMS-IV alcohol abuse at 1.0 per 100 person years and alcohol dependence at 1.7 per 100 person years; data also indicate that the greatest risk for alcohol use disorders occurs during young adulthood (Grant et al., 2008).

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