Social costs of illegal drugs, alcohol and tobacco in the European Union: a systematic review

Abstract

Background: Addiction accounts for one of the main disease groups in the European Union (EU). There is therefore an increasing need to evaluate the economic consequences of addiction, both to individuals and to society, in order to develop appropriate policies. Methods: A systematic search of relevant databases and publications was conducted. Studies reporting on social costs of illegal drugs, alcohol and tobacco in EU countries were included. Methodology, cost components and total costs were extracted from individual studies. To compare across studies, final costs were transformed to 2014 Euros. Findings: 42 studies were included (illegal drugs:8, alcohol:26, tobacco:8). The main methodologies employed were prevalence estimates and the human capital approach. While there was a constant inclusion of direct costs related to treatment of substance use and comorbidities, there was a high variability for the rest of cost components. Total costs showed great variability between studies. Price per capita for the year 2014 ranged from 0.38e to 78€ for illegal drugs, from 26€ to 1500€ for alcohol and from 10.55 to 391€ for tobacco. A rough estimate for the total cost of addiction to the EU zone revealed it ranges between 1,2% and 3.9% of the total gross domestic product. Conclusions: Addiction imposes a heavy economic burden to Europe. Given the high methodological heterogeneity that exists in the field, and in order to better assess this burden and to effectively develop adequate policies, methodological guidance is needed.