Skip to main content
Log in

Clinical Issues Related to the Costs of Alcoholism

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

Alcohol (ethanol) use disorders are prevalent in many countries and are associated with significant social and health costs. Little is known, however, about the comparative cost effectiveness of treatments for alcoholism. Pharmacoeconomic evaluations are largely (if not wholly) absent from the alcoholism treatment outcome database. We discuss pharmacological approaches to the treatment of alcohol withdrawal and dependence, describing agents that ameliorate withdrawal symptoms, deter alcohol consumption, reduce alcohol craving and produce conditioned alcohol aversion. Cost-relevant clinical considerations are elucidated and recommendations for cost-conscious pharmacological treatment of alcohol dependence are proffered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Clark WB, Hilton ME. Alcohol in America: drinking practices and problems. Albany (NY): State University of New York Press, 1991

    Google Scholar 

  2. Heizer JE, Burnam A, McEvoy LT. Alcohol abuse and dependence. In: Robins CN, Regier DA, editors. Psychiatric disorders in America: the epidemiologic catchment area study. New York: Free Press, 1991

    Google Scholar 

  3. Stinson FS, Parrish K, Noble J. Epidemiologic bulletin no. 25: alcohol consumption in a 1986 sample of deaths. Alcohol Health Res World 1990; 14: 154–62

    Google Scholar 

  4. Wilsnack SL, Klassen AD, Schur BE. Predicting onset and chronicity of women’s problem drinking: a five-year longitudinal analysis. Am J Public Health 1991; 81: 305–18

    Article  PubMed  CAS  Google Scholar 

  5. Heizer JE, Canino GJ, editors. Alcoholism in North America, Europe, and Asia. New York: Oxford University Press, 1992

    Google Scholar 

  6. McDonald M, editor. Gender, drink, and drugs. Providence (RI): Berg, 1994

    Google Scholar 

  7. Segal BM. The drunken society: alcohol abuse and alcoholism in the Soviet Union: a comparative study. New York: Hippocrene Books, 1990

    Google Scholar 

  8. Grant BF, Harford TC, Dawson DA, et al. Epidemiologic bulletin no. 35: prevalence of DSM-IV alcohol abuse and dependence: United States, 1992. Alcohol Health Res World 1991; 18: 243–8

    Google Scholar 

  9. Jarman CMB, Kellett JM. Alcoholism in a general hospital. BMJ 1979; 2: 469–72

    Article  PubMed  CAS  Google Scholar 

  10. Bell J, The E, Patel A, et al. The detection of at-risk drinking in a teaching hospital. Med J Aust 1988; 149: 351–5

    PubMed  CAS  Google Scholar 

  11. Rice DP, Kelman S, Miller LS, et al. The economic costs of alcohol and drug abuse and mental illness: 1985. Report submitted to the Office of Financing and Coverage Policy of the Alcohol, Drug Abuse, and Mental Health Administration, US Department of Health and Human Services. San Francisco (CA): Institute for Health and Aging, University of California, 1990

    Google Scholar 

  12. Rice DP. The economic cost of alcohol abuse and alcohol dependence: 1990. Alcohol Health Res World 1993; 17: 10–1

    Google Scholar 

  13. Harwood HJ, Napolitano DM, Kristiansen PL, et al. Economic costs to society of alcohol and drug abuse and mental illness: 1980. Report submitted to the Office of Program Planning and Coordination of the Alcohol, Drug Abuse, and Mental Health Administration, US Department of Health and Human Services. Research Triangle Park (NC): Research Triangle Institute, 1984

    Google Scholar 

  14. Nakamura K, Tanaka A, Takano T. The social cost of alcohol abuse in Japan. J Stud Alcohol 1993; 54: 618–25

    PubMed  CAS  Google Scholar 

  15. Hocking B, Grain H, Gordon I. Cost to industry of illnesses related to alcohol and smoking: a study of Telecom Australia employees. Med J Aust 1994; 161: 407–12

    PubMed  CAS  Google Scholar 

  16. Holder H, Longabaugh R, Miller WR, et al. The cost-effectiveness of treatment for alcoholism: a first approximation. J Stud Alcohol 1991; 52: 517–40

    PubMed  CAS  Google Scholar 

  17. Howard MO. Assessing the comparative cost-effectiveness of alcoholism treatments: a comment on Holder, Longabaugh, Miller, and Rubonis. J Stud Alcohol 1993; 54: 667–75

    PubMed  CAS  Google Scholar 

  18. Hester RK, Miller WR, editors. Handbook of alcoholism treatment approaches: effective alternatives. 2nd ed. Needham Heights (MA): Allyn & Bacon, 1995

    Google Scholar 

  19. Gallant D. Alcohol. In: Galanter M, Kleber H, editors. Textbook of substance abuse treatment. Washington, DC: American Psychiatric Press, 1994

    Google Scholar 

  20. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994: 198

    Google Scholar 

  21. Schuckit MA. Guidelines for the treatment of alcohol withdrawal. Psychiatr Lett 1987; 5: 13–20

    Google Scholar 

  22. Feldman DJ, Pattison EM, Sobell LC, et al. Outpatient detoxification: initial findings on 564 patients. Am J Psychiatry 1975; 132: 407–12

    PubMed  CAS  Google Scholar 

  23. Stockwell T, Bolt L, Milner I, et al. Home detoxification from alcohol: its safety and efficacy in comparison with inpatient care. Alcohol Alcohol 1991; 26: 645–50

    PubMed  CAS  Google Scholar 

  24. Hayashida M, Alterman AI, McLellan AT, et al. Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome. N Engl J Med 1989; 320: 358–65

    Article  PubMed  CAS  Google Scholar 

  25. Beshai NN. Providing cost efficient detoxification services to alcoholic patients. Public Health Rep 1990; 105: 475–81

    PubMed  CAS  Google Scholar 

  26. Sullivan JT, Sykora K, Schneiderman J, et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict 1989; 84: 1353–7

    Article  PubMed  CAS  Google Scholar 

  27. Adinoff B. The alcohol withdrawal syndrome. Am J Addict 1994; 3: 277–88

    Google Scholar 

  28. Adinoff B, O’Neill K, Ballenger JC. Alcohol withdrawal and limbic kindling: a hypothesis of relapse. Am J Addict 1995; 4: 5–17

    Google Scholar 

  29. Ballenger JC, Post RM. Kindling as a model for alcohol withdrawal syndromes. Br J Psychiatry 1978; 133: 1–14

    Article  PubMed  CAS  Google Scholar 

  30. Lechtenberg R, Worner TM. Relative kindling effect of detoxification and nondetoxification admissions in alcoholics. Alcohol Alcohol 1991; 26: 221–5

    PubMed  CAS  Google Scholar 

  31. Adinoff B. Double-blind study of alprazolam, diazepam, clonidine and placebo in the alcohol withdrawal syndrome: preliminary findings. Alcohol Clin Exp Res 1994; 18: 873–8

    Article  PubMed  CAS  Google Scholar 

  32. Red Book. Montvale (NJ): Medical Economics Company Inc., 1995

  33. Arana GW, Hyman SE, editors. Handbook of psychiatric drug therapy. 2nd ed. Boston: Little, Brown and Company, 1991: 132

    Google Scholar 

  34. Rosenbloom AJ. Optimizing drug treatment of alcohol withdrawal. Am J Med 1986; 81: 901–4

    Article  PubMed  CAS  Google Scholar 

  35. Gelenberg AJ, Bassuk EL, Schooner SC, editors. The practitioner’s guide to psychoactive drugs. 3rd ed. New York: Plenum Medical Book Company, 1991: 214

    Google Scholar 

  36. Greenblatt DJ, Shader RI, MacLeod SM, et al. Absorption of oral and intramuscular chlordiazepoxide. Eur J Clin Pharmacol 1978; 13: 267–74

    Article  PubMed  CAS  Google Scholar 

  37. Butler D, Messiha F. Alcohol withdrawal and carbamazepine. Alcohol 1986; 3: 113–29

    Article  PubMed  Google Scholar 

  38. Malcolm R, Ballenger JC, Sturgis ET, et al. Double-blind controlled trial comparing carbamazepine to oxazepam treatment of alcohol withdrawal. Am J Psychiatry 1989; 146: 617–21

    PubMed  CAS  Google Scholar 

  39. Pinel JPJ. Alcohol withdrawal seizures: implications of kindling pharmacology. Biochem Behav Suppl 1980; 13: 225–31

    Article  Google Scholar 

  40. Roy-Byrne PP, Ward NG, Donneil PJ. Valproate in anxiety and withdrawal syndromes. J Clin Psychiatry 1989; 50: 44–8

    PubMed  Google Scholar 

  41. Ries RK, Roy-Byrne PP, Ward NG, et al. Carbamazepine treatment for benzodiazepine withdrawal. Am J Psychiatry 1989; 146: 536–7

    PubMed  CAS  Google Scholar 

  42. Baumgartner GR, Rowen RC. Transdermal clonidine versus chlordiazepoxide in alcohol withdrawal: a randomized, controlled clinical trial. South Med J 1991; 84: 312–21

    Article  PubMed  CAS  Google Scholar 

  43. Kraus ML, Gottlieb LD, Horwitz RI, et al. Randomized clinical trial of atenolol in patients with alcohol withdrawal. N Engl J Med 1985; 313: 905–9

    Article  PubMed  CAS  Google Scholar 

  44. Worner TM. Propranolol versus diazepam in the management of the alcohol withdrawal syndrome: double blind controlled trial. Am J Drug Alcohol Abuse 1994; 20: 115–24

    Article  PubMed  CAS  Google Scholar 

  45. Liskow BI, Goodwin DW. Pharmacological treatment of alcohol intoxication, withdrawal, and dependence: a critical review. J Stud Alcohol 1987; 48: 356–70

    PubMed  CAS  Google Scholar 

  46. Robinson GN, Sellers EM, Janacek E. Barbiturate and hypnosedative withdrawal by multiple oral phenobarbital loading dose techniques. Clin Pharmacol Ther 1981; 30: 71–6

    Article  PubMed  CAS  Google Scholar 

  47. Cushman P, Forbes R, Lerner W, et al. Alcohol withdrawal syndromes: clinical management with lofexidine. Alcohol Clin Exp Res 1985; 9: 103–8

    Article  PubMed  Google Scholar 

  48. Sullivan JT, Swift RM, Lewis DC. Benzodiazepine requirements during alcohol withdrawal syndrome: clinical implications of using a standardized withdrawal scale. J Clin Psychopharmacol 1991; 11: 291–5

    Article  PubMed  CAS  Google Scholar 

  49. Wartenberg AA, Nirenberg TD, Liepman MR, et al. Detoxification of alcoholics: improving care by symptom-triggered sedation. Alcohol Clin Exp Res 1990; 14: 71–5

    Article  PubMed  CAS  Google Scholar 

  50. Saitz R, Mayo-Smith MF, Roberts MS, et al. Individualized treatment for alcohol withdrawal: a randomized double-blind controlled trial. JAMA 1994; 272: 519–23

    Article  PubMed  CAS  Google Scholar 

  51. Hoey LL, Nahum A, Vance-Bryan K. A prospective evaluation of benzodiazepine guidelines in the management of patients hospitalized for alcohol withdrawal. Pharmacotherapy 1994; 14: 579–85

    PubMed  CAS  Google Scholar 

  52. Brewer C. Controlled trials of Antabuse in alcoholism: the importance of supervision and adequate dosage. Acta Psychiatr Scand Suppl 1992; 369: 51–8

    Article  PubMed  CAS  Google Scholar 

  53. Chick J, Gough K, Falkowski W, et al. Disulfiram treatment of alcoholism. Br J Psychiatry 1992; 161: 84–9

    Article  PubMed  CAS  Google Scholar 

  54. Wright C, Moore RD. Disulfiram treatment of alcoholism. Am J Med 1990; 88: 647–55

    Article  PubMed  CAS  Google Scholar 

  55. Fuller RK, Branchey L, Brightwell DR, et al. Disulfiram in the treatment of alcoholism: a Veterans Administration cooperative study. JAMA 1986; 256: 1449–55

    Article  PubMed  CAS  Google Scholar 

  56. Fuller RK, Roth HP. Disulfiram for the treatment of alcoholism: an evaluation of 128 men. Ann Intern Med 1979; 90: 901–4

    PubMed  CAS  Google Scholar 

  57. Brewer C. Recent developments in disulfiram treatment. Alcohol Alcohol 1993; 28: 383–95

    PubMed  CAS  Google Scholar 

  58. Enghusen-Poulsen H, Loft S, Andersen JR, et al. Disulfiram therapy — adverse drug reactions and interactions. Acta Psychiatr Scand Suppl 1992; 369: 59–65

    Article  PubMed  CAS  Google Scholar 

  59. Wright C, Vafier JA, Lake RC. Disulfiram-induced fulminating hepatitis: guidelines for liver-panel monitoring. J Clin Psychiatry 1988; 49: 430–4

    PubMed  Google Scholar 

  60. Obach R, Torrent J, Colom H, et al. Pharmacokinetics and oral bioavailability of carbimide in man. Biopharm Drug Dispos 1991; 12: 425–34

    Article  PubMed  CAS  Google Scholar 

  61. Johnsen J, Stowell A, Morland J. Clinical responses in relation to blood acetaldehyde levels. Pharmacol Toxicol 1992; 70: 41–5

    Article  PubMed  CAS  Google Scholar 

  62. Levy MS, Livingstone BL, Collins DM. A clinical comparison of disulfiram and calcium carbimide. Am J Psychiatry 1967; 123: 1018–22

    PubMed  CAS  Google Scholar 

  63. Moreno A, Vazquez JJ, Ruizdel AI, et al. Structural hepatic changes associated with cyanamide treatment: cholangiolar proliferation, fibrosis and cirrhosis. Liver 1984; 4: 15–21

    PubMed  CAS  Google Scholar 

  64. Greenstein RA, Arndt IC, McLellan AT, et al. Naltrexone: a clinical perspective. J Clin Psychiatry 1984; 45: 25–8

    PubMed  CAS  Google Scholar 

  65. Froelich JC, Li TK. Recent developments in alcoholism: opioid peptides. Recent Dev Alcohol 1993; 11: 187–205

    Google Scholar 

  66. Swift RM, Whelihan W, Kuznetsov O, et al. Naltrexone-induced alterations in human ethanol intoxication. Am J Psychiatry 1994; 151: 1463–7

    PubMed  CAS  Google Scholar 

  67. O’Malley SS, Jaffe AJ, Chang G, et al. Naltrexone and coping skills therapy for alcohol dependence. Arch Gen Psychiatry 1992; 49: 881–7

    Article  PubMed  Google Scholar 

  68. Volpicelli JR, Alterman AI, Hayashida M, et al. Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry 1992; 49: 876–80

    Article  PubMed  CAS  Google Scholar 

  69. O’Brien CP. Opioids: antagonists and partial agonists. In: Galanter M, Kleber HD, editors. Textbook of substance abuse treatment. Washington, DC: American Psychiatric Press, 1994

    Google Scholar 

  70. Thomason HH, Dilts SL. Opioids. In: Frances RJ, Miller SI, editors. Clinical textbook of addictive disorders. New York: Guildford Press, 1991

    Google Scholar 

  71. Physicians desk reference. Montvale (NJ): Medical Economics Data Production Company, 1995: 965–6

  72. Myers RD. New drugs for the treatment of experimental alcoholism. Alcohol 1994; 11: 439–51

    Article  PubMed  CAS  Google Scholar 

  73. Naranjo CA, Bremner KE. Serotonin-altering medications and desire, consumption and effects of alcohol — treatment implications. In: Jansson B, Jarrvall H, Rydber U, et al., editors. Toward a molecular basis of alcohol use and abuse. Basel: Birkhauser Verlag, 1994: 209–19

    Chapter  Google Scholar 

  74. Naranjo CA, Bremner KE, Poulos CX, et al. Fluoxetine decreases desire for alcohol [abstract]. Clin Pharmacol Ther 1992; 51: 168

    Article  Google Scholar 

  75. Naranjo CA, Poulos CX, Bremner KE, et al. Citalopram decreases desirability, liking, and consumption of alcohol in alcohol dependent drinkers. Clin Pharmacol Ther 1992; 51: 729–39

    Article  PubMed  CAS  Google Scholar 

  76. Naranjo CA, Kadlec KE, Sanhueza P, et al. Fluoxetine differentially alters alcohol intake and other consummatory behaviors in problem drinkers. Clin Pharmacol Ther 1990; 47: 490–8

    Article  PubMed  CAS  Google Scholar 

  77. Gorelick DA, Paredes A. Effect of fluoxetine on alcohol consumption in male alcoholics. Alcohol Clin Exp Res 1992; 16: 451–6

    Article  Google Scholar 

  78. Naranjo CA, Bremner KE, Lanctot KL. Short and long term effects of citalopram combined with a brief psychosocial intervention for alcoholism [abstract]. Clin Pharmacol Ther 1992; 51: 168

    Article  Google Scholar 

  79. Koob GF, Bloom FE. Cellular and molecular mechanisms of drug dependence. Science 1988; 242: 715–23

    Article  PubMed  CAS  Google Scholar 

  80. Shaw GK, Majumdar SK, Waller S, et al. Tiapride in the long-term management of alcoholics of anxious or depressive temperament. Br J Psychiatry 1987; 150: 164–8

    Article  PubMed  CAS  Google Scholar 

  81. Peters DH, Faulds D. Tiapride: a review of its pharmacology and therapeutic potential in the management of alcohol dependence syndrome. Drugs 1994; 47: 1010–32

    Article  PubMed  CAS  Google Scholar 

  82. Dongier M, Vachon L, Schwartz G. Bromocriptine in the treatment of alcohol dependence. Alcohol Clin Exp Res 1991; 15: 970–7

    Article  PubMed  CAS  Google Scholar 

  83. Howard MO, Elkins RL, Rimmele C, et al. Chemical aversion treatment of alcohol dependence. Drug Alcohol Depend 1991; 29: 107–43

    Article  PubMed  CAS  Google Scholar 

  84. Rackham H. Pliny’s natural history, books I–II. Cambridge (MA): Harvard University Press, 1938

    Google Scholar 

  85. Rush B. An inquiry into the effects of ardent spirits upon the human body and mind with an account of the means of prevention and the remedies of curing them. Vol. I. 4th ed. Philadelphia: Griggs and Dickinsons, 1815

    Google Scholar 

  86. Kantorovich NV. An attempt at curing alcoholism by associated reflexes. Psychol Abstracts 1930; 4: 4282

    Google Scholar 

  87. Howard MO, Jenson JM. Chemical aversion treatment of alcohol dependence: I. Validity of current criticisms. Int J Addict 1990; 25: 1227–62

    PubMed  CAS  Google Scholar 

  88. Howard MO, Jenson JM. Chemical aversion treatment of alcohol dependence: II. Future research directions for the nineties. Int J Addict 1990; 25: 1403–14

    PubMed  CAS  Google Scholar 

  89. Smith JW. Treatment of alcoholism in aversion conditioning hospitals. In: Pattison EM, Kaufman E, editors. Encyclopedic handbook of alcoholism. New York: Gardner, 1982

    Google Scholar 

  90. Elkins RL. An appraisal of chemical aversion (emetic therapy) approaches to alcoholism treatment. Behav Res Ther 1991; 29: 387–413

    Article  PubMed  CAS  Google Scholar 

  91. Elkins RL. Chemical aversion (emetic therapy) treatment of alcoholism: further comments. Behav Res Ther 1991; 29: 421–8

    Article  Google Scholar 

  92. Wilson GT. Chemical aversion conditioning as a treatment for alcoholism: a re-analysis. Behav Res Ther 1987; 25: 503–16

    Article  PubMed  CAS  Google Scholar 

  93. Wilson GT. Chemical aversion conditioning in the treatment of alcoholism: further comments. Behav Res Ther 1991; 29: 415–9

    Article  PubMed  CAS  Google Scholar 

  94. Cannon DS, Baker TB, Wehl CK. Emetic and electric shock alcohol aversion therapy: six- and twelve-month follow-up. J Cons Clin Psychol 1981; 49: 360–8

    Article  CAS  Google Scholar 

  95. Loomis TA, Drill VA, Friess SL. Emetine risk analysis for the Shadel Hospital aversion therapy program [unpublished manuscript]. Arlington (VA): Drill, Friess, Hays, Loomis, Schaeffer, Consultants in Toxicology, 1986

    Google Scholar 

  96. American Medical Association. Council on Scientific Affairs. Aversion therapy. JAMA 1987; 258: 2562–6

    Article  Google Scholar 

  97. Kattwinkel EE. Death due to cardiac disease following the use of emetine hydrochloride in conditioned-reflex treatment of chronic alcoholism. N Engl J Med 1949; 240: 995–7

    Article  PubMed  CAS  Google Scholar 

  98. O’Hollaren P, Lemere F. Conditioned-reflex treatment of chronic alcoholism: results obtained in 2,323 net cases from 3,125 admissions over a period of ten and half years. N Engl J Med 1948; 239: 331–3

    Article  PubMed  Google Scholar 

  99. Voegtlin WL, Lemere F, Broz WR. Conditioned reflex therapy of alcoholic addiction: III. An evaluation of present results in the light of previous experiences in this method. Q J Stud Alcohol 1948; 1: 501–16

    Google Scholar 

  100. Boland FJ, Mellor CS, Revusky S. Chemical aversion treatment of alcoholism: lithium as the aversive agent. Behav Res Ther 1978; 16: 401–9

    Article  PubMed  CAS  Google Scholar 

  101. Pohl RW, Revusky S, Mellor CS. Drugs employed in the treatment of alcoholism: rat data suggest they are unusually severe. Behav Res Ther 1980; 18: 71–8

    Article  PubMed  CAS  Google Scholar 

  102. Revusky S, Gory TH. Flavor aversions produced by contingent drug injection: relative effectiveness of apomorphine, emetine, and lithium. Behav Res Ther 1973; 11: 403–9

    Article  PubMed  CAS  Google Scholar 

  103. Arwas S, Rolnick A, Lubow RE. Conditioned taste aversions in humans using motion-induced sickness in the U.S. Behav Res Ther 1989; 27: 295–301

    Article  PubMed  CAS  Google Scholar 

  104. Mellor CS, White HD. Taste aversions to alcoholic beverages conditioned by motion sickness. Am J Psychiatry 1978; 135: 125–6

    PubMed  CAS  Google Scholar 

  105. Lamon S, Wilson GT, Leaf RC. Human classical conditioning: nausea versus electrical shock in the reduction of target beverage consumption. Behav Res Ther 1977; 15: 313–20

    Article  PubMed  CAS  Google Scholar 

  106. Rimmele CT, Howard MO, Hilfrink ML. Aversion therapies. In: Hester DK, Miller WR, editors. Handbook of alcoholism treatment approaches: effective alternatives. 2nd ed. Needham Heights (MA): Allyn & Bacon, 1995

    Google Scholar 

  107. Hodgson TA. Costs of illness in cost-effectiveness analysis. PharmacoEconomics 1994; 6: 536–52

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Howard, M.O., McGuffin, R.W., Saxon, A.J. et al. Clinical Issues Related to the Costs of Alcoholism. Pharmacoeconomics 9, 134–145 (1996). https://doi.org/10.2165/00019053-199609020-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199609020-00005

Keywords

Navigation