Economic costs of excessive alcohol consumption in the U.S., 2006

A meta-analysis provided an alcohol-attributable fraction of 0.058 for nonfatal unintentional injuries other than traffic crashes.

“A meta-analysis assessing alcohol involvement among people treated in emergency departments 8 provided AAFs for nonfatal violent injuries (0.267) and unintentional injuries other than those related to traffıc crashes (0.058).”

• cites [8] 8. Cherpitel CJ, Ye Y, Bond J. Attributable risk of injury associated with alcohol use: cross national data from the emergency room collaborative alcohol analysis project. Am J Public Health 2005;95:266 -72, Table 3. sourcePartly supported

  The Results (Table 3; page unavailable) give 0.058 as the pooled attributable fraction for all-cause injuries, not specifically for nonfatal unintentional injuries excluding traffic crashes. The same table supports the citing sentence’s 0.267 figure for violence-related injuries. The paper uses meta-analytic techniques, but it does not report the claimed injury-specific fraction. (LLM, conf=0.89)

  Experimental — accuracy not yet measured

A meta-analysis provided an alcohol-attributable fraction of 0.267 for nonfatal violent injuries.

“A meta-analysis assessing alcohol involvement among people treated in emergency departments 8 provided AAFs for nonfatal violent injuries (0.267) and unintentional injuries other than those related to traffıc crashes (0.058).”

• cites [8] 8. Cherpitel CJ, Ye Y, Bond J. Attributable risk of injury associated with alcohol use: cross national data from the emergency room collaborative alcohol analysis project. Am J Public Health 2005;95:266 -72, Table 3. sourceSupported

The estimated total economic cost of excessive drinking was $223.5 billion in 2006.

“The estimated total economic cost of excessive drinking was $223.5 billion in 2006.”

• AssumptionRests on an assumption: The definition of excessive alcohol consumption used in the study is consistent with CDC and NIAAA standards used to identify harmful patterns of alcohol consumption.

On a per capita basis, the cost of excessive drinking was approximately $746 for each man, woman, and child in the U.S. in 2006.

“On a per capita basis, this cost was approximately $746 for each man, woman, and child in the U.S. in 2006.17”

• cites [17] 17. National Institute on Alcohol Abuse and Alcoholism. National epide- miologic survey on alcohol and related conditions.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

$92.9 billion (41.5%) of the total economic cost was borne by excessive drinkers and their family members.

“while almost as much $92.9 billion (41.5%) was borne by excessive drinkers and their family members (Table 2).”

• AssumptionRests on an assumption: Costs related to excessive alcohol consumption may be borne by many others than those who excessively drink and their families.

The excessive drinker and their household bore 10.3% of the $24.6 billion in total healthcare expenditures related to excessive alcohol consumption.

“By cost category, the excessive drinker and their household bore 10.3% of the $24.6 billion in total healthcare expenditures related to excessive alcohol consumption.”

• AssumptionRests on an assumption: Costs related to excessive alcohol consumption may be borne by many others than those who excessively drink and their families.

Lost productivity accounted for 61.4% of the costs of underage drinking.

“Lost productivity accounted for 61.4% of the costs.”

Of the $24.6 billion in health expenditures attributable to alcohol, 20.8% was from hospitalizations for other medical conditions stemming from excessive drinking.

“Of the $24.6 billion in health expenditures attributable to alcohol, 43.4% was from specialty treatment for alcohol abuse and dependence and another 20.8% from hospitalizations for other medical conditions stemming from excessive drinking (Table 1).”

Comparing the 2006 estimate of $223.5 billion to those from 1992 and 1998 shows an annualized increase of 3.0%.

“Nonetheless, comparing the 2006 estimate of $223.5 billion to those from 1992 and 1998 3,4 shows an annualized increase of 3.0%.”

• cites [3] 3. Harwood H, Fountain D, Livermore G. The economic costs of alcohol and drug abuse in the U.S., 1992. Report prepared for the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, NIH, DHHS. Rockville MD: NIH, 1998. NIH Publi- cation No. 98-4327.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [4] 4. Harwood H. Updating estimates of the economic costs of alcohol abuse in the U.S.: estimates, update methods and data. Report prepared by the Lewin Group for the National Institute on Alcohol Abuse and Alcohol- ism, 2000.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Of the total cost, $24.6 billion (11.0%) came from increased healthcare costs.

“Of the total cost, $161.3 billion (72.2%) came from lost productivity; $24.6 billion (11.0%) came from increased healthcare costs; $21.0 billion (9.4%) came from criminal justice costs; and $16.7 billion (7.5%) came from other effects (Table 1).”

Of the $5.2 billion attributable to drinking while pregnant, 95.3% was related to fetal alcohol syndrome.

“Of this $5.2 billion, 95.3% was related to FAS.”

Of the total cost, $161.3 billion (72.2%) came from lost productivity.

“Of the total cost, $161.3 billion (72.2%) came from lost productivity; $24.6 billion (11.0%) came from increased healthcare costs; $21.0 billion (9.4%) came from criminal justice costs; and $16.7 billion (7.5%) came from other effects (Table 1).”

The largest share of the productivity losses related to underage drinking was related to premature mortality, representing 25.1% of all costs associated with underage drinking.

“The largest share of the productivity losses was related to premature mortality representing 25.1% of all costs associated with underage drinking.”

Overall, $94.2 billion (42.1%) of the total economic cost of excessive alcohol use was borne by government, including federal, state, and local government agencies.

“Overall, $94.2 billion (42.1%) of the total economic cost of excessive alcohol use was borne by government, including federal, state, and local government agencies, while almost as much $92.9 billion (41.5%) was borne by excessive drinkers and their family members (Table 2).”

• AssumptionRests on an assumption: Costs related to excessive alcohol consumption may be borne by many others than those who excessively drink and their families.

The cost associated with drinking during pregnancy was $5.2 billion.

“The cost associated with binge drinking was $170.7 billion, underage drinking $27.0 billion, drinking during pregnancy $5.2 billion, and crime $73.3 billion (note that these subcategories are not mutually exclusive and may overlap; Table 1).”

Of the total cost, $16.7 billion (7.5%) came from other effects.

“Of the total cost, $161.3 billion (72.2%) came from lost productivity; $24.6 billion (11.0%) came from increased healthcare costs; $21.0 billion (9.4%) came from criminal justice costs; and $16.7 billion (7.5%) came from other effects (Table 1).”

The cost associated with crime was $73.3 billion.

“The cost associated with binge drinking was $170.7 billion, underage drinking $27.0 billion, drinking during pregnancy $5.2 billion, and crime $73.3 billion (note that these subcategories are not mutually exclusive and may overlap; Table 1).”

Of the $21.0 billion in criminal justice system costs, 76.8% came from crimes that would not be thought of as solely alcohol-attributable (e.g., assault).

“Of the $21.0 billion in criminal justice system costs, 76.8% came from crimes that would not be thought of as solely alcohol-attributable (e.g., assault) as opposed to obviously alcohol-attributable crimes like driving under the influence of alcohol.”

There were 360,785 alcohol-attributable hospitalizations (0.9% of all hospitalizations) in community hospitals.

“There were 360,785 alcohol-attributable hospitalizations (0.9% of all hospitalizations) in community hospitals; 2.785 million physician offıce visits (0.31% of all such visits); 0.329 million hospital outpatient department visits (0.32% of total); and 1.272 million emergency department visits (1.07% of emergency department visits) for a total of 4.386 million outpatient visits (0.39% of all outpat”

Of the total cost, $21.0 billion (9.4%) came from criminal justice costs.

“Of the total cost, $161.3 billion (72.2%) came from lost productivity; $24.6 billion (11.0%) came from increased healthcare costs; $21.0 billion (9.4%) came from criminal justice costs; and $16.7 billion (7.5%) came from other effects (Table 1).”

The distribution of healthcare costs is highly skewed toward large values.

“For example, the distribution of healthcare costs is highly skewed toward large values.”

Overall, 12.1% of the economic costs of excessive alcohol consumption were related to underage drinking.

“Overall, 12.1% of the economic costs of excessive alcohol consumption were related to underage drinking (Table 1).”

There was an estimated 19.269 million days spent institutionalized or hospitalized for care resulting from excessive drinking.

“There was also an estimated 19.269 million days spent institutionalized or hospitalized for care resulting from excessive drinking and, depending on age group, 0.4 -0.9 days lost to absenteeism per year for female binge drinkers and 0.5-1.2days for male binge drinkers.”

The total economic cost of excessive alcohol use in 2006 was about $1.90 per standard drink.

“Thus, the total economic cost of excessive alcohol use in 2006 was about $1.90 per standard drink.”

There were 4.386 million outpatient visits (0.39% of all outpatient visits) attributable to excessive drinking.

“for a total of 4.386 million outpatient visits (0.39% of all outpatient visits) attributable to excessive drinking.”

There were 11,976 (0.80%) nursing home admissions attributable to excessive drinking.

“In addition, there were 11,976 (0.80%) nursing home admissions that were attributable to excessive drinking.”

Of the $24.6 billion in health expenditures attributable to alcohol, 43.4% was from specialty treatment for alcohol abuse and dependence.

“Of the $24.6 billion in health expenditures attributable to alcohol, 43.4% was from specialty treatment for alcohol abuse and dependence and another 20.8% from hospitalizations for other medical conditions stemming from excessive drinking (Table 1).”

The econometric models found no reduction in workplace or household productivity for alcohol-dependent women.

“First, the econometric models found that there was no reduction in workplace or household productivity for alcohol-dependent women.”

A total of $5.2 billion (2.3%) of the total economic cost of excessive drinking was attributable to drinking while pregnant.

“A total of $5.2 billion (2.3%) of the total economic cost of excessive drinking was at-tributable to drinking while pregnant (Table 1).”

The cost associated with underage drinking was $27.0 billion.

“The cost associated with binge drinking was $170.7 billion, underage drinking $27.0 billion, drinking during pregnancy $5.2 billion, and crime $73.3 billion (note that these subcategories are not mutually exclusive and may overlap; Table 1).”

The government expense for excessive alcohol consumption equated to about $0.80 per standard drink consumed in 2006.

“Considering the $94.196 billion paid by government for excessive alcohol consumption, this government expense equated to about $0.80 per standard drink consumed in 2006.”

The total estimated cost of excessive drinking in the U.S. in 2006 was $223.5 billion.

“Although the $223.5 billion fıgure is the best currently available estimate of the cost of excessive drinking for 2006”

The cost associated with binge drinking was $170.7 billion.

“The cost associated with binge drinking was $170.7 billion, underage drinking $27.0 billion, drinking during pregnancy $5.2 billion, and crime $73.3 billion (note that these subcategories are not mutually exclusive and may overlap; Table 1).”

• AssumptionRests on an assumption: Binge drinking typically results in legal intoxication, defined as a blood alcohol level of at least 0.08 g/dL.

12%-15% of inmates incarcerated for non-index crimes reported having drunk enough to be intoxicated at the time of the crime.

“However, 12%-15% of inmates incarcerated for non-index crimes reported having drunk enough to be intoxicated at the time of the crime.”

The AAFs for nonfatal injuries used in this study were lower than those reported in other studies.

“The AAFs for nonfatal injuries that were used in this study were lower than those reported in other studies.[28][29][30]”

• cites [28][29][30]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Overall, $170.7 billion (76.4%) of the total costs were attributed to binge drinking.

“Overall, $170.7 billion (76.4%) of the total costs were attributed to binge drinking (Table 1).”

• AssumptionRests on an assumption: Binge drinking typically results in legal intoxication, defined as a blood alcohol level of at least 0.08 g/dL.

Government paid 42.1% of the total cost of excessive drinking in 2006.

“Percentage of total | 100.0 | 42.1 | 18.2 | 23.9 | 41.5 | 16.3”

Had average wage been used, the loss due to incarceration would have increased to $20.8 billion from $6.3 billion (a 330% increase).

“Had average wage been used, the loss due to incarceration would have increased to $20.8 billion from $6.3 billion (a 330% increase).”

Only 68.5% of specialty treatment costs for the abuse/dependent population were included in binge drinking estimates.

“only 68.5% of specialty treatment costs for the abuse/dependent population were included in binge drinking estimates.”

For crime, the alcohol-attributable fraction for homicide from ARDI was used because it considers drinking by the perpetrator and not just drinking by the victim.

“For crime, the AAF for homicide from ARDI 6 was used because this AAF considers drinking by the perpetrator and not just drinking by the victim.”

• cites [6] 6. Alcohol and Public Health. Online tools. Alcohol-Related Disease Im- pact (ARDI) software. www.cdc.gov/alcohol/ardi.htm.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Since 1998, there have been no comprehensive national estimates of the costs of excessive alcohol consumption.

“Since then, there have been no comprehensive national estimates of the costs of excessive alcohol consumption.5”

• cites [5] 5. Navarro HJ, Doran CM, Shakeshaft AP. Measuring costs of alcohol harm to others: a review of the literature. Drug Alcohol Depend 2011;114:87-99. sourceNot checked — no full text of the source

A 1998 update estimated the economic cost of alcohol abuse at $184.6 billion.

“A comprehensive analysis 3 estimated the 1992 economic cost of alcohol abuse at $148 billion; a 1998 update 4 put the fıgure at $184.6 billion.”

• cites [4] 4. Harwood H. Updating estimates of the economic costs of alcohol abuse in the U.S.: estimates, update methods and data. Report prepared by the Lewin Group for the National Institute on Alcohol Abuse and Alcohol- ism, 2000.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

For fire-related outcomes, an alcohol-attributable fraction of 0.05 was used based on a National Fire Protection Association study.

“For fıre-related outcomes, an AAF of 0.05 was used based on a National Fire Protection Association study.10”

• cites [10] 10. Ahrens, M. Possible impairment by alcohol or drugs as a factor in reported fıres. Quincy MA: National Fire Protection Association, May 2009.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

A comprehensive analysis estimated the 1992 economic cost of alcohol abuse at $148 billion.

“A comprehensive analysis 3 estimated the 1992 economic cost of alcohol abuse at $148 billion; a 1998 update 4 put the fıgure at $184.6 billion.”

• cites [3] 3. Harwood H, Fountain D, Livermore G. The economic costs of alcohol and drug abuse in the U.S., 1992. Report prepared for the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, NIH, DHHS. Rockville MD: NIH, 1998. NIH Publi- cation No. 98-4327.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The CDC's ARDI system was used as the basis for selecting the specific alcohol-attributable conditions included in the analysis of health-related costs.

“The CDC's ARDI system 6 was used as the basis for selecting the specifıc alcohol-attributable conditions that were included in the analysis of health-related costs, including deaths and healthcare expenditures related to excessive drinking.”

• cites [6] 6. Alcohol and Public Health. Online tools. Alcohol-Related Disease Im- pact (ARDI) software. www.cdc.gov/alcohol/ardi.htm.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

For nonfatal traffic injuries, an alcohol-attributable fraction of 0.061 was derived from a National Highway Traffic Safety Administration study of injury-producing crashes involving BACs of at least 0.10 g/dL.

“For nonfatal traffıc injuries, an AAF of 0.061 was derived from a National Highway Traffıc Safety Administration study of injury-producing crashes involving BACs of Ն0.10 g/dL.9”

• cites [9] 9. Blincoe L, Seay A, Zaloshnja E, et al. The economic impact of motor vehicle crashes, 2000 (NHTSA technical report). May 2002. Washing- ton DC: U.S. Dept. of Transportation, National Highway Traffıc Safety Administration, Table 10.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Using conservative cost estimates where presented with choices likely resulted in underestimation.

“Third, using conservative cost estimates where presented with choices likely resulted in underestimation.”

The zero estimate of productivity reduction for alcohol-dependent women is more likely due to imprecise estimation from data problems than to a true absence of effect.

“This zero estimate defıes biologic plausibility and is more likely due to imprecise estimation resulting from several common problems and data gaps that plague attempts to estimate women's wages”

If the 1998 estimate had simply been inflated to 2006 based on population and relevant price increases, the estimated 2006 cost would have been $265 billion.

“In fact, if the 1998 estimate had simply been inflated to 2006 based on population and relevant price increases, the estimated 2006 cost would have been $265 billion (productivity losses $192 billion, health losses $40 billion, and other costs $34 billion) versus the $223.5 billion estimated.”

Costs resulting from reduced presenteeism due to excessive drinking were not included.

“Costs resulting from reduced presenteeism (i.e., reduced workplace productivity due to excessive drinking were not included).”

Direct costs associated with increased length of hospital stay from comorbid alcohol problems were not included.

“For example, direct costs associated with increased length of hospital stay from comorbid alcohol problems were not included”

The BAC cut-point used in this study to define fatal alcohol-attributable acute conditions (>0.10 g/dL) was conservative compared to the legal blood alcohol limit (0.08 g/dL) used in all states.

“The BAC cut-point used in this study to define fatal alcohol-attributable acute conditions (i.e., a BAC Ͼ0.10 g/dL) was conservative compared to the legal blood alcohol limit (0.08 g/dL) used in all states.”

According to NIAAA, 550,761,000 gallons of ethanol in the form of 7,538,026,000 total gallons of beer, wine, and spirits were consumed in the U.S. in 2006.

“According to the NIAAA, 550,761,000 gallons of ethanol in the form of 7,538,026,000 total gallons of beer, wine, and spirits were consumed in the U.S. in 2006, 19”

• cites [19] 19. Annual estimates of the population for the U.S., regions, and states, and for Puerto Rico: April 1, 2000 to July 1, 2006. www.census.gov/popest/ states/tables/NST-EST2006-01.xls.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

AAF estimates based on ED data may be conservative because of delays in seeking treatment and incomplete or underreporting of alcohol involvement.

“AAF estimates based on ED data may be conservative because of delays in seeking treatment and incomplete or underreporting of alcohol involvement.”

The $223.5 billion estimate is a substantial underestimate of the true cost of excessive drinking in 2006.

“the authors believe it is a substantial underestimate.”

• AssumptionRests on an assumption: Alcohol-attributable conditions are generally under-recognized and under-reported in the healthcare system.
• AssumptionRests on an assumption: Victims of alcohol-attributable violence incur higher healthcare costs and more intensive use of services than non-abused counterparts.
• AssumptionRests on an assumption: Early-onset drinking and heavy alcohol consumption at an early age are associated with increased negative outcomes and long-term costs.

Alcohol involvement in crime was likely under-reported.

“Alcohol involvement in crime was likely to have been under-reported.”

Using only the primary (first-listed) diagnosis to assess alcohol-attributable healthcare costs likely excluded many alcohol-attributable encounters with a non-alcohol-related primary diagnosis but an alcohol-attributable root cause.

“Using only the primary (first-listed) diagnosis to assess alcohol-attributable healthcare costs likely resulted in the exclusion of many alcohol-attributable encounters (e.g., hospitalizations with a non-alcohol-related primary diagnosis such as bleeding) but with an alcohol-attributable root cause (e.g., alcoholic cirrhosis of the liver).”

Treatment costs, productivity losses, and special education costs for fetal alcohol syndrome were taken from a 2004 study.

“Treatment costs, productivity losses, and special education costs for fetal alcohol syndrome were taken from a 2004 study.14”

• cites [14] 14. Mark TL, Levit KR, Coffey RM, et al. National expenditures for mental health services and substance abuse treatment, 1993-2003.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Comparing the 2006 estimates to those from 1992 and 1998 is problematic because there were several methodologic differences among the studies.

“Comparing the 2006 estimates to those from 1992 and 1998 3,4 is problematic because there were several methodologic differences among the studies”

• cites [3] 3. Harwood H, Fountain D, Livermore G. The economic costs of alcohol and drug abuse in the U.S., 1992. Report prepared for the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, NIH, DHHS. Rockville MD: NIH, 1998. NIH Publi- cation No. 98-4327.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [4] 4. Harwood H. Updating estimates of the economic costs of alcohol abuse in the U.S.: estimates, update methods and data. Report prepared by the Lewin Group for the National Institute on Alcohol Abuse and Alcohol- ism, 2000.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

ED data may underestimate alcohol involvement for people hospitalized for injuries because alcohol involvement tends to increase with injury severity.

“ED data may also underestimate alcohol involvement for people hospitalized for injuries because alcohol involvement tends to increase with injury severity.”

The $4.4 billion cost of absenteeism for excessive drinkers who were alcohol dependent was not included to avoid potential overlap with estimated earnings losses.

“The $4.4 billion cost of absenteeism for excessive drinkers who were alcohol dependent was not included to avoid potential overlap with estimated earnings losses.”

AAF estimates based on Medical Examiner data for deaths from acute conditions may be conservative because of alcohol metabolism and interventions administered prior to death.

“AAF estimates based on Medical Examiner data for deaths from acute conditions may be conservative because of alcohol metabolism and interventions (e.g., fluid replacement) administered prior to death.”

The estimated $223.5 billion cost of excessive drinking in 2006 is on a par with the costs of other major health-risk behaviors.

“The estimated $223.5 billion cost of excessive drinking in 2006 is on a par with the costs of other major health-risk behaviors.”

In the current study, reported cost distributions were truncated at the 95th percentile to reduce the impact of outliers on average expenditures for emergency department visits, hospital outpatient department visits, and office visits.

“In the current study, reported cost distributions were truncated at the 95th percentile to reduce the impact of outliers on costs related to average expenditures for emergency department visits, hospital outpatient department visits, and offıce visits.”

The percentage of individuals with alcohol dependence or alcohol abuse who reported binge drinking in the past 30 days in the National Epidemiologic Survey on Alcohol and Related Conditions was 68.5%.

“the percentage of individuals with alcohol dependence or alcohol abuse who reported binge drinking in the past 30 days in the National Epidemiologic Survey on Alcohol and Related Conditions (68.5%) 15 was used to estimate the proportion of costs related to these conditions that were due to binge drinking”

• cites [15] 15. Rockville MD, Substance Abuse and Mental Health Services Administration. SAMHSA Publication SMA 07-4227. csat.samhsa.gov/IDBSE/spendEst/ reports/SAMHSAFINAL9303.pdf.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Many potentially alcohol-related conditions (e.g., pneumonia, tuberculosis, influenza, hepatitis C, sudden infant death syndrome, and sexually transmitted diseases) were not included in the cost estimates.

“As in ARDI, many potentially alcohol-related conditions (e.g., pneumonia, tuberculosis, influenza, hepatitis C, sudden infant death syndrome, and sexually transmitted diseases) were not included.”

The U.S. consumption in 2006 corresponded to 117.4 billion standard drinks.

“or 117.4 billion standard drinks ([gallons consumed multiplied by the specifıc gravity of ethanol, the weight of 1 gallon of water, and the number of grams in 1 lb] divided by the grams of ethanol in a standard drink [i.e., 14.0]), 20”

• cites [20] 20. CMS Centers for Medicare and Medicaid Services. National health expenditure data. www.cms.hhs.gov/NationalHealthExpendData/02_ NationalHealthAccountsHistorical.asp#TopOfPage.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The $5.368 billion in 2006 state and local tax revenues from alcohol and $9.194 billion in federal excise taxes on alcohol in 2006 do not begin to cover the economic costs of excessive alcohol consumption.

“The $5.368 billion in 2006 state and local tax revenues from alcohol 34 and $9.194 billion in federal excise taxes on alcohol in 2006 35 do not begin to cover the economic costs.”

• cites [34] 34. Porter RS. Alcohol and injury in adolescents. Pediatr Emerg Care 2000;16(5):316 -20.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [35] 35. Lupton C. The fınancial impact of fetal alcohol syndrome, SAMHSA FASD Center for Excellence, 2003. www.fasdcenter.samhsa.gov/publi- cations/cost.cfm.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Subgroup estimates are similarly underestimated.

“Subgroup estimates are similarly underestimated.”

The current study did not estimate intangible costs like pain, suffering, and bereavement.

“Finally, the current study did not estimate intangible costs like pain, suffering, and bereavement.”

Research has shown that the non-gender-specific definition of binge drinking underestimates binge drinking among women by about 35%.

“Research 24 has shown this underestimates binge drinking among women by about 35%.”

• cites Research 24Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The costs associated with early-onset drinking and heavy alcohol consumption at an early age were not included in the cost estimates.

“Also, although early-onset drinking and heavy alcohol consumption at an early age have been associated with increased negative outcomes and long-term costs, these costs were not included.”

• AssumptionRests on an assumption: Early-onset drinking and heavy alcohol consumption at an early age are associated with increased negative outcomes and long-term costs.

The economic impact of excessive alcohol consumption is quite comparable to the economic impact of other leading health-risk behaviors, such as smoking and physical inactivity.

“Despite these limitations, this study shows that the economic impact of excessive alcohol consumption is quite comparable to the economic impact of other leading healthrisk behaviors, such as smoking and physical inactivity.”

For underage drinking, the AAFs for nonfatal injuries are probably higher than those used in the current study.

“For underage drinking, AAFs for nonfatal injuries are probably higher than those the current study used.32”

• cites [32] 32. MacLeod JB, Hungerford DW. Alcohol-related injury visits: do we know the true prevalence in U.S. trauma centres? Injury 2010;41: 847-51. sourceNot checked — no full text of the source

For the analysis of lost productivity due to alcohol-associated incarceration, inmates' time was valued at minimum wage rather than at the average worker's wage.

“Fifth, for the analysis of lost productivity due to alcohol-associated incarceration, inmates' time was valued at minimum wage rather than at the average worker's wage.”