Fiscal Effects of Increasing the Alcohol Excise Tax

Alcohol is a drug or it isn't!  Read outrage on Alcohol being excluded from the "Drug Policy" efforts
Findings from a 1994 study suggest that alcohol advertising may predispose young people to drinking.  As a result, efforts to prevent drinking and driving problems among young people should give attention to countering the potential effects of alcohol advertising. (Grube, et al, 1994)

The availability of alcohol within a community can influence drinking rates and related problems (Drug Strategies, 1999)

Recent advertising expenditures in the United States for beer, wine, and liquor combined ($1.2 billion) totaled more than 10 times the amount spent on milk ads ($70.5 million).   A total of $764.2 million was spent on beer ads, $131.5 million on wine ads, and $291.2 million on liquor ads. (Adams Business Media, Blisard, N. et al, 1999)

More than 40 percent of individuals who start drinking before the age of 13 will develop alcohol abuse or alcohol dependence at some point in their lives.  (Grant, B.F et al, 1997) 

Our Purpose  
Alcohol Policy Quick List.

We continue to get letters of outrage that policy makers have not been responsible in addressing the public health needs as a result of alcohol availability.

 We must respond by reminding our friends "Legislators work for you, they are your employees, they are accountable to you, the citizens of this country,  if you do not like that 90% of the nations policy makers are being funded by the Alcohol Industries lobby, then let them know" at the end of the day, we must be accountable for doing this, and we have the ability to do so.

E-Mail Legislators in Louisiana
Check out Thomas for Federal Legislation! Track and follow bills in your area of interest, free online public service.

 

1.  Have you written a letter supporting efforts to identify the relationship with media, alcohol, and the lack of labeling on alcohol?

  Have you asked for legislation enabling "Fee for use" meaning those who choose to drink paying adequate taxes to cover the costs of consumption in our communities (why should hard working tax payers trying to make a living foot the bill for the costs and consequences of alcohol consumption in our communities?  This is a dollars and sense issue, not a "moral" issue.  We have grave consequences in all aspects of our communities  related to the effect of alcohol consumption,  most people are not heavy drinkers, if they drink at all, yet all taxpayers get to pick up the tab for alcohol costs.

Why Taxpayers are responsible for this industries tab.....

Louisiana's Lax Policy, Strong support in cultural norms and genetic predisposition for abuse/dependence in consumption.

More people use alcohol than use any other psychoactive drug. That’s because it’s legal for people over the age of 21, skillfully marketed and promoted and widely available. Also, more people get into trouble with alcohol. Alcohol is implicated in the deaths of 100,000 Americans every year, making it the nation’s third leading cause of preventable death.

Alcohol & Our Problem
Accidents in which drinking is a factor are alcohol problems. Alcoholism is an alcohol problem. A substance that gives pleasure to most people also kills 100,000 Americans annually, causes serious injury, harms youth, destroys families and plays a significant role in violent crime. Some 20-40 percent of patients in large urban hospitals are there because their drinking has caused or contributed to the illness for which they were admitted. The estimated economic cost of alcohol problems in the U.S. was $185 billion in 1998, $638 each year for every man, woman and child.
 

What is alcoholism? Is it a disease?
Like many other diseases, alcoholism is chronic, meaning that it lasts a person’s lifetime. Individuals may require treatment a few times before they successfully stop drinking. They may also need continuing help to maintain their recovery. Treatment often must be extensive and sustained in order to be effective.

Alcoholism results in chemical and biological changes in the brain. People with alcoholism have a strong need or urge to drink, an inability to stop drinking even if there are serious family, health or legal problems, withdrawal symptoms when they stop drinking, and the need to drink greater amounts of alcohol to get “high” of even feel normal.

Alcoholism usually follows a predictable course and has predictable symptoms. The risk for developing alcoholism is influenced both by a person's genes and by his or her lifestyle. Relationships, the amount of stress in one’s life, and the availability of alcohol are other factors that may increase the risk for alcoholism. However, anyone who drinks can develop the disease.

(Download this report)  Louisiana Costs of Alcohol-Attributable to Traffic Crashes
* Involving Youth by State (in 1998 dollars)(million)

State Medical Care  $35,793,800

Work Lost & Other Costs $95,240,000

Pain & Lost of Quality of Life $218,747,200

 Total  $349,781,000

Alcohol and Crime-4 in 10 violent victimizations
involve use of alcohol, about 4 in 10 fatal motor vehicle
accidents are alcohol-involved; and about 4 in 10 offenders,
regardless of whether they are on probation, in local jail, or
in State prison, self-report that they were using alcohol at the
time of the offense. read the National Report

Communities Pay the Lion’s Share of Costs Associated with Problem Drinking

• Alcohol-related problems cost every man, woman and child in American roughly $683 (in 1998 dollars) each year.
• The cost of alcohol problems includes lost productivity (70 percent); health care expenditures to treat alcoholism and other medical consequences (14 percent); alcohol-related motor vehicle crashes (8 percent); and alcohol-related crime (3 percent).
• Almost half (45 percent) of the cost of alcohol problems is borne by problem drinkers and their households. Society also pays for the negative effects of alcohol use: the federal government pays 20 percent, primarily in reduced tax revenue as a result of productivity losses; state and local governments pay 18 percent in reduced tax revenue, crime and motor vehicle crash costs; private insurers pay 10 percent in life, health, auto and fire insurance; and the victims of alcohol-related crime and the non-drinking victims of motor vehicle crashes pay 6 percent.

Alcohol-Impaired Driving Remains Major Public Health Problem

• About three out of every 10 Americans will be involved in an alcohol-related traffic crash during their lifetime.
• Forty percent of people killed in alcohol-related traffic crashes were people other than the drinking driver.
• Binge drinkers (those who consumed five or more drinks at a single sitting during the past month) are 30 times more likely to drive while impaired than those who do not binge.
• Nearly three-quarters of drivers convicted of driving while impaired are either problem drinkers or alcoholics.

Crime Severity Increases With Alcohol Consumption

• Twenty-five percent of violent crime victims – nearly three million people – report that the perpetrator had been drinking before committing the crime; only five percent were under the influence of drugs other than alcohol.
• The more serious the crime, the more likely alcohol is involved.
• Alcohol use is a factor in as many as 47 percent of murders, 15 percent of robberies, 26 percent of aggravated and simple assaults, and 37 percent of rapes and sexual assaults.

Alcohol’s Availability Impacts Kids and Neighborhoods

• The majority of 8th and 10th graders report it is easier to buy alcohol than cigarettes in their communities.
• Adults who purchase alcohol for minors and businesses that sell alcohol to minors are rarely prosecuted for violations of minimum drinking age laws. For every 1,000 minors arrested for alcohol possession, criminal penalties are faced by only 130 of the businesses and only 88 of the adults.
• Violence occurs more often in neighborhoods where alcohol is widely available than in those where it is not.

Sources: McGinnis, J.M., & Foege, W.H., “Actual causes of death in the United States,” Journal of the American Medical Association 270(18):2207-2212, 1993.

U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, “10th Special Report to the U.S. Congress on Alcohol and Health: Highlights from Current Research,” June, 2000.

December 2002

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Alcohol and the Family

• Alcoholism is a disease of the family. Not only is there a significant genetic component that is passed from generation to generation, but the drinking problems of a single family member affect all other family members. The family environment and genetics can perpetuate a vicious and destructive cycle.
• Many marriages break up over a husband’s or wife’s drinking. Domestic violence typically erupts when one or both spouses have been drinking, and drinking makes domestic violence more dangerous.
• Families play a critical role in recovery from alcoholism. They can be instrumental in encouraging an alcoholic family member to seek treatment. Strong family support also increases the chances for successful recovery.

Alcoholism and Problem Drinking Pervasive in Family Life

• More than half of adults have a close family member who has had alcoholism or is still dealing with alcoholism.
• Approximately one in four children younger than 18 is exposed to alcoholism or problem drinking in the family.

A Factor in Many Serious Family Problems

• Separated and divorced men and women are three times as likely to say their spouse was alcoholic or had a drinking problem than men and women who are still married.
• Some 75 percent of husbands or wives who abuse their spouses have been drinking prior to or at the time of the abuse.
• Women who have heavy drinking husbands or partners are at higher risk for developing their own drinking problems.
• Each year 4,000-12,000 babies are born with the physical signs and intellectual disabilities associated with fetal alcohol syndrome (FAS), and thousands more experience the somewhat lesser disabilities of fetal alcohol effects. FAS is the leading preventable cause of mental retardation in the United States.
• Children of alcoholics are at high risk for developing problems with alcohol and other drugs; they often do poorly at school, live with pervasive tension and stress, have high levels of anxiety and depression and experience coping problems.

Underage Drinking Challenges American Youth

• First use of alcohol typically begins around age 13. By their senior year, 64 percent of high school students say they have been drunk at least once; 33 percent say they have been drunk in the past month.
• Among teenagers between the ages of 12 and 17 who say they drink heavily (five or more drinks on five or more occasions in the past month); 77 percent had at least one serious problem related to drinking in the past year; 63 percent had built up tolerance to the effects of alcohol; 20 percent reported psychological problems related to their drinking; 12 percent reported health problems related to their drinking.
• Teenagers who drink heavily are more likely to cut class or skip school, perform poorly in school, take sexual risks, and commit suicide. Heavy drinking increases the likelihood of delinquent and violent behavior including running away from home, fighting, vandalizing property, stealing and getting arrested.

Attitudes in the Home Influence Youth Drinking

• Even in families where alcoholism isn’t present, permissive attitudes about alcohol can have a profound impact on youth. Though far more kids drink than use illicit drugs, parents are more likely to excuse getting drunk as a “rite of passage.” Unless a car is involved, some just don’t take it seriously.
• Parents who drink and who have favorable attitudes about alcohol encourage children to start drinking and to keep drinking.
• Drinking by older siblings can influence the alcohol use of younger siblings, particularly for same-sex siblings.

Sources: U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, “Youth Drinking: Risk Factors and Other Consequences,” Alcohol Alert No. 37, July 1997.

Dawson, D.A., & Grant, B.F., “Family history of alcoholism and gender: Their combined effects on DSM-IV alcohol dependence and major depression,” Journal of Studies on Alcohol, 59(1):97-106, 1998.

Greenblatt, JC., “Patterns of Alcohol Use Among Adolescents and Associations with Emotional and Behavioral Problems,” U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, March 2000.

Greenfeld L, “Alcohol and Crime: An Analysis of National Data on the Prevalence of Alcohol Involvement in Crime,” Bureau of Justice Statistics, Report # NCJ-168632, 1998.

U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, “10th Special Report to the U.S. Congress on Alcohol and Health: Highlights from Current Research,” June 2000.

U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, “Drinking in the United States: Main Findings from the 1992 National Longitudinal Alcohol Epidemiologic Survey,” 1998.

National Institute on Drug Abuse, “Monitoring the Future: National Results on Adolescent Drug Use, Overview of Key Findings,” 2001.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, “Youth and Underage Drinking: An Overview,” “The Role of Parents in Preventing and Addressing Underage Drinking,” SAMHSA Fact Sheets, 2000.

National Council on Alcoholism and Drug Dependence, Inc., “Youth, Alcohol and Other Drugs Fact Sheet,” December 1999.

December 2002

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Alcohol Problems Cost American Business

Employee alcohol use causes a variety of problems. It reduces productivity, impairs job performance, increases health care costs and can threaten public safety. Because 85 percent of heavy drinkers work, employers who aggressively address this problem can improve their own company’s bottom line and their employees’ health. For more information, see the Ensuring Solutions fact sheet Challenges to Solving Alcohol Problems at Work.

Any Way You Look At It, Alcohol Costs

• The federal government estimates that in 2001, 7.4 percent of full-time workers ages 18 to 49 – 6.5 million people – were alcoholic or problem drinkers.
• The same study found that 8.1 percent (7.1 million people) drank heavily during the past month, potentially putting themselves and others at risk.
• Alcohol costs American business an estimated $134 billion in productivity losses, mostly due to missed work: 65.3 percent of this cost was caused by alcohol-related illness, 27.2 percent due to premature death, and 7.5 percent to crime.
• Alcoholics and problem drinkers are more likely than other workers to have had three or more employers during the last year; to have missed work more than two days in the past month due to illness or injury; and to have skipped work more than two days in the past month.
• Alcoholics use twice as much sick leave as other employees. They are five times more likely to file workmen's compensation claims; and they are more likely to cause injuries to themselves or others while on the job.
• Twenty percent of workers say they have been injured, have had to cover for a coworker, or needed to work harder because of other employees’ drinking.
• More than half of working family members of alcoholics report that their own ability to function at work and at home was negatively impacted by their family member’s drinking.

Drinking Doesn't Have To Occur On the Job to Cause Problems in the Workplace

• Employees who drink heavily off the job are more likely to experience hangovers that cause them to be absent, show up late or leave early; to feel sick at work; to sleep on the job; to perform poorly; or to argue with their coworkers.
• Sixty percent of alcohol-related job performance problems are caused by people who are NOT alcoholics or problem drinkers; they are employees who occasionally drink too much at lunch or the night before.
• One study found that pilots were unable to perform adequately on a flight simulator 8-14 hours after drinking heavily.

Workplace Demographics Influence the Extent of Problem Drinking

• Drinking varies among occupations and gender, but alcohol-related problems cut across the workforce just as they do in the rest of American society.
• Heavy drinking is more likely to occur in male-dominated workplaces such as construction and mining.
• In predominantly female occupations, both men and women are less likely to drink than employees of both sexes in male-dominated occupations.
• Workforces with a large number of young adults have much greater rates of problem drinking than workforces that are older. Problem drinking among younger workers is associated with increased injury, absenteeism and productivity losses.

Sources: Mangione, TW, Howland, J & Lee, M., "New Perspectives for Worksite Alcohol Strategies: Results from a Corporate Drinking Study,” December 1998.

The Washington Business Group on Health, “Proceedings from the Employer Leadership Forum on Substance Abuse: An Exploratory Conference,” November 1999.

U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, “Alcohol and the Workplace,” Alcohol Alert No. 44, July 1999.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, "Substance Use, Dependence or Abuse among Full-time Workers," The National Household Survey on Drug Abuse, September 2002.

Al-Anon Family Groups, Inc., “1999 Al-Anon/Alateen Membership Survey and Al-Anon Membership Assessment Results: Final Report,” March 2000.

The Hazelden Foundation, "Workplace Recovery Benefits Survey," September 2002.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, “The Costs and Effects of Parity for Substance Abuse Insurance Benefits,” 1998.

December 2002

Challenges to Solving Alcohol Problems at Work

Contrary to stereotypes, a whopping 85 percent of heavy drinkers work. Their alcohol problems cost American businesses millions of dollars. But there are many cost-effective steps that employers can take that will undoubtedly save them both money and heartache in the long run. For more information, see the Ensuring Solutions fact sheet Alcohol Problems Cost American Business.

Workers Who Want Help Face Barriers

• More than one in five people with employer-provided health insurance are afraid that seeking alcohol treatment will cause them problems at work. Specific fears include being fired, losing a license, or not being promoted.
• Ninety-two percent of large- and middle-sized companies offer employees less generous health insurance coverage for treatment of alcoholism than for treating other chronic illnesses.

Employees Often Drink Because of the Environment at Work

• Repetitive tasks, limited opportunities to make job-related decisions, general lack of control over work conditions and disrespectful behavior – including sexual, verbal and physical harassment–can alienate employees and make them more vulnerable to problem drinking.
• Company leaders who set the tone for their employees can create a corporate culture that condones drinking, even excessive drinking.
• Managers have more opportunities than hourly employees to drink while working when they go out for lunch and attend business functions where drinks are served.
• At one large manufacturing plant, nearly two-thirds of the workers surveyed said it was easy or very easy to bring alcohol onto the premises and to drink on breaks or even while working; of these, 24 percent said that they had had a drink at work during the previous year.

Efforts to Reduce Employee Drinking Face Many Challenges

• Managers offer a variety of reasons for overlooking alcohol problems in the workplace:
  • 58 percent say companies are soft on alcohol use but tough on illicit drugs
  • 49 percent have paid a price for confronting an employee with alcohol problems
  • 43 percent say unions protect problem drinkers
  • 80 percent say they haven’t been trained properly to confront an employee with alcohol problems
  • 73 percent indicate that employees with alcohol problems still do an adequate job
• Enforcement of alcohol policies can take a back seat to pressures on supervisors to keep production lines moving; supervisors may use disciplinary measures only when an employee’s drinking noticeably interferes with production or threatens safety.
• Many managers say that Employee Assistance Programs (EAPs) do not equip them with proper intervention tools and techniques for dealing with problem drinkers whose work hasn't suffered. EAPs offer short-term, immediate but limited, help.

Sources: Mangione, TW, Howland, J & Lee, M, “New Perspectives for Worksite Alcohol Strategies: Results from a Corporate Drinking Study," December 1998.

The Washington Business Group on Health, “Proceedings from the Employer Leadership Forum on Substance Abuse: An Exploratory Conference,” November 1999.

U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, “Alcohol and the Workplace,” Alcohol Alert No. 44, July 1999.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, "Substance Use, Dependence or Abuse among Full-time Workers," The National Household Survey on Drug Abuse, September 2002.

Al-Anon Family Groups, Inc., “1999 Al-Anon/Alateen Membership Survey and Al-Anon Membership Assessment Results: Final Report,” March 2000.

The Hazelden Foundation, "Workplace Recovery Benefits Survey," September 2002.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, “The Costs and Effects of Parity for Substance Abuse Insurance Benefits,” 1998.

December 2002

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Treating Alcohol Problems Early

People don’t develop alcohol problems overnight. But like diabetes, heart disease and other chronic illnesses, there are many opportunities to prevent and treat, or intervene, at an early stage. The federal government recommends that all patients be screened for alcohol problems during routine health exams, before they are prescribed medications that interact with alcohol and when they are diagnosed with illnesses such as hypertension, depression and sleep disorders that are frequently associated with alcohol use.

• If detected, alcohol problems can be effectively treated in ways that are less costly and prevent more serious illness. If it is not detected, alcohol-related problems and health effects can lead to very serious illnesses. For more on treatment of alcohol-related problems at later stages, see the Ensuring Solutions fact sheet What Is Alcohol Treatment And How Does It Work?
• Voluntary screenings and brief interventions are effective strategies for treating alcohol problems.
• Physicians routinely measure a patient’s blood pressure to diagnose hypertension but less than one in three carefully screen their patients for alcohol problems.

Why Don’t More Physicians Conduct Clinically-proven Screenings and Brief Interventions?

• Insurance reimbursement issues are one concern, particularly in emergency rooms and trauma centers, where insurance companies can deny coverage for injuries caused by alcohol impairment in 42 states and the District of Columbia.
• Some physicians and health care workers doubt the effectiveness of alcohol screening and brief intervention. Others assume that the process is too difficult and time consuming, that they aren’t qualified, or that their patients will react badly.
• Brief interventions, simple screening tests (www.alcoholscreening.org), questionnaires and laboratory tests have been clinically-proven effective as methods to discern alcohol problems in patients.

Doctor’s Offices Effective for Screening and Brief Interventions

• Seventy percent of Americans – 191 million people – visit a primary care physician at least once every two years.
• One in five men and one in ten women seen by primary care physicians drink at levels that put them at risk for alcohol-related problems, including alcoholism.
• Patients trust their health care providers and are more likely to take seriously advice about their use of alcohol when it is given during visits to their doctors’ offices.
• By raising a patient’s level of concern about alcohol-related problems, alcohol screening by itself can result in a patient drinking less.

Brief Interventions Are Effective, Inexpensive

• Patients with alcohol problems typically appreciate health care providers who express concern about their drinking, and cooperate in the brief intervention process.
• Brief interventions at the doctor’s office – an initial counseling session lasting five to 20 minutes and one or more follow-up sessions – can help problem drinkers reduce their alcohol consumption and health care utilization.
• Brief interventions can be successful outside of the doctor’s office. For emergency department and trauma center patients, identification of alcohol as a factor in their injury (either through objective tests such as blood alcohol level or screening questionnaire) along with a motivational interview when they are discharged, reduced subsequent drinking and cuts emergency department admissions during the six months following brief treatment.
• Adolescent and older populations are particularly responsive to brief interventions.
• Brief interventions are not designed to treat alcoholism, which requires greater expertise and more intensive case management, but they may be helpful in motivating alcoholic patients to engage in more intensive and long term treatment.

Brief Interventions Are Useful in Busy Health Care Practices

• In a brief intervention, the health provider expresses medical concern about a patient’s drinking; advises the patient to cut down his or her drinking, or in the case of an alcoholic, to stop drinking
• Primary care physicians or nursing staff can conduct brief interventions in the course of five or fewer standard office visits.
• Only five to 20 percent of patients who are screened require brief intervention.
• If more physicians were to treat alcoholism as a chronic disease, there would be greater opportunity for early intervention among problem drinkers and better outcomes for alcoholics. This, in turn, would foster a public health approach that would go a long way towards reducing the stigma that prevents so many problem drinkers and alcoholics from seeking help.

Sources: U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, “10th Special Report to the U.S. Congress on Alcohol and Health: Highlights from Current Research,” June 2000.

U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert No. 49, “New Advances in Alcoholism Treatment,” October 2000.

Babor, T & Higgins-Biddle, J, “Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary Care,” World Health Organization, 2001.

Watkins, K, Pincus, H, & Tanielian, T, “Evidence Based Care Models for Recognizing and Treating Alcohol Problems in Primary Care Settings,” RAND Health, 2001.

CASA, “Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse,” The Survey Research Laboratory, University of Illinois at Chicago, May 2000.

December 2002

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What is Alcohol Treatment and How Does It Work?

Alcoholism can be treated similarly to other chronic diseases such as hypertension, diabetes and asthma in adults. There are a variety of treatment options, depending on the individual’s particular situation and needs.

• Clinical studies have repeatedly found that treatment substantially reduces drinking among alcoholics.
• Many alcoholics, like individuals with other illnesses, need to use a variety of services to treat their illnesses.
• Even if alcoholics relapse during their treatment, their lives, their families, their workplace and society at large benefit for as long as they remain abstinent.
• Largely due to the success of Alcoholics Anonymous (AA) and other voluntary recovery organizations, some alcoholics recover without medical treatment.
• Many alcoholics are required to participate in a self-help group as a substitute for medical treatment. For example, people who are arrested for driving while intoxicated are routinely referred to AA by the judicial system when a brief medical intervention in a doctor’s office might be more appropriate and help stop a problem drinker from becoming an alcoholic.

There Are Many Steps in Alcohol Treatment

• Detoxification helps alcoholics through withdrawal and is often the first step toward treatment. Persons with severe dependence on alcohol may need medication and close medical management during detoxification, sometimes requiring brief hospitalization.
• Social skills training, motivational enhancement, cognitive therapy, marriage and family counseling, aversion therapy and relaxation training are among the many psychological therapies used to treat alcoholics.
• Many psychological therapies have been used to treat alcoholics successfully, though no single therapy has proven superior to others in achieving long-term recovery.
• Alcoholics may have a better chance of achieving long-term recovery if they receive appropriate services for their other problems, which can include drug addiction, depression, unemployment and domestic violence.
• Outpatient treatment works best for alcoholics with strong social support systems and without other medical or mental health problems. Alcoholics with other disorders and/or a lack of strong social support may do better if they are treated in a hospital.

New Medications Target Brain Chemistry

• Naltrexone was approved by the Food and Drug Administration (FDA) in 1995 to prevent relapse in alcoholics who are undergoing psychological therapy; it works by blocking the “high” that alcoholics seek when they drink.
• Acamprosate, a drug that has been available in Europe for more than 10 years, is now under FDA review. It targets a different pathway in the brain than naltrexone and may have fewer side effects.
• Disulfiram (Antabuse), the only medication previously approved to treat alcoholism, makes patients violently sick when they drink alcohol.

More People Need Alcoholism Treatment Than Get It

• Although two to three million Americans receive clinical treatment for alcoholism annually, this represents only 20 percent of those who need it.
• Access to treatment is most limited for adolescents and older Americans.

Relapse Rates for Alcoholism, Other Chronic Illnesses Comparable

• Forty percent of treated alcoholics remain abstinent after a year; another 15 percent resume drinking though not to the point where they become dependent again.
• During the course of a year, 30 percent of diabetics and 40 percent of patients with high blood pressure or asthma will suffer a reoccurrence of their symptoms.

Sources: Harwood, H, Sullivan, K, Malhotra, D., “Prevalence and Access to Substance Abuse and Mental Health Treatment,” Draft report to the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2001.

McLellan AT, Lewis DC, O’Brien CP and Kleber HD., “Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation,” Journal of the American Medical Association, 284(13), October 2000.

U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, “10th Special Report to the U.S. Congress on Alcohol and Health: Highlights from Current Research,” June 2000.

Fuller, RK & and Hiller-Sturmhöfel, S., “Alcoholism Treatment in the United States: An Overview,” Alcohol Health & Research World, National Institute on Alcohol Abuse and Alcoholism, Vol. 23, No. 2, 1999.

U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, “New Advances in Alcoholism Treatment,” Alcohol Alert No. 49, October 2000.

December 2002

Who Pays for Alcohol Treatment?

Public funding, not private health insurance, pays for most of Americans’ alcohol treatment, even though the majority of problem drinkers are employed. In virtually all other areas of medical care, private insurance pays the lion’s share of costs.

• Taxpayers are the single largest funder of alcohol treatment services – over 57 percent of alcohol treatment is paid with public funds. For general health care costs, public sources pay only 45 percent of the costs.
• State and local governments are picking up the largest portion of the public tab – 19.2 percent, not including Medicaid.
• Federal government programs – block grants, entitlements and categorical grants – make up the smallest portion.
• Individuals pay almost 8 percent of the cost of alcohol treatment services themselves, out-of-pocket.

• Private health and other insurance make up 34.5 percent of the funding for alcohol treatment services.
• Forty-four states require private health insurance plans to cover alcohol treatment in some fashion, with some laws requiring more expansive coverage than others. If companies choose to self-insure, or administer their own health plans, they are exempt from state insurance laws. Just under half of all workers who have health insurance through their jobs are covered by self-insured plans.
• According to a recent report from the National Governors Association, “Private insurers traditionally have been reluctant to provide coverage for substance abuse treatment, mainly because of its perceived costs and the availability of government-supported services.”

Sources: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, “National Expenditures for Mental Health, Alcohol, and Other Drug Abuse Treatment: 1996,” 2000.

National Governors Association, “Substance Abuse: State Actions to Aid Recovery,” NGA Center for Best Practices Issue Brief, October 11, 2002.

December 2002

State Laws, Health Insurance, and Alcohol Treatment

• Forty-four states require health plans to cover alcohol treatment in some fashion, with some laws requiring more expansive coverage than others. If companies choose to self-insure, or administer their own health plans, they are exempt from state insurance laws. Just under half of all workers who have health insurance through their jobs are covered by self-insured plans