Cost-of-alcohol studies as a research programme

AIMS - According to the literature, estimates of the costs of alcohol abuse serve four main purposes: They draw attention to the severity of alcohol problems, they help to target specific problems and policies, they identify information gaps and they provide a baseline for future cost-effectiveness studies. This paper evaluates to which extent these purposes have been met in recent studies and how likely they can be met in the future. METHOD - Critical review. MATERIAL - Thirty reports on alcohol costs published after 2000. CONCLUSIONS - Even the most sophisticated cost-of-alcohol calculations include entries based on misleading assumptions or logical mistakes. Monetary calculations do not add precision to the comparison of the weight of health problems. Cost calculations cannot be used to compare the extent or nature of alcohol problems in different countries. Cost calculations should focus on money spent from clearly defined budgets. Calculating the costs to "society" is not a promising research program. It is good to measure the joys and sorrows of heavy drinkers and their nearest, but the use of a monetary metric conceals important issues and value judgments. As a research program, the cost-of-alcohol tradition is based on promises about future cost-effectiveness studies, but traditional measures of alcohol problems offer a better picture of the effects of policy measures than cost-of-alcohol estimates.