The estimated loss of potential productivity because of long-term residential treatment and short-term hospitalization of alcohol and drug abusers was $3 billion in 1992; drug problems cost $1.5 billion, and alcohol problems, $1.5 billion.
There were an estimated 63,800 clients in long-term residential alcohol and drug abuse treatment programs on a given day in 1991 (Harwood et al. 1994). Most clients enrolled in long-term treatment programs are not allowed to hold jobs until very near the end of their treatment stay, so enrollment in treatment amounts to a temporary loss of potential employment. It was estimated in Harwood et al. (1984) that the average loss of potential productivity per person-year from long-term treatment was $24,600 after adjustments for expected rates of labor force participation, unemployment, and household productivity. Wage rates of nonmanagerial workers increased 59 percent between 1980 and 1992, yielding annual potential productivity of $39,000. This has been arbitrarily adjusted downward by about 10 percent, to $35,000, because the treatment population in 1991 was somewhat younger on average (median age of 31 years versus 34 years) and had a slightly greater proportion of females (24 percent versus 22 percent).
Total loss of potential productivity resulting from long-term residential treatment of alcohol and drug abusers was thus estimated at $2.233 billion in 1992. Losses for clients with primary drug problems were $694 million, whereas losses for clients with primary alcohol problems were $577 million and losses for clients with both drug and alcohol problems were $962 million. When the costs for the dually affected clients were prorated (among those with a single problem, about 55 percent had drug problems and 45 percent had alcohol problems), the loss attributed to drug problems was $1.222 billion (54.6 percent), versus $1.011 attributed to alcohol problems. It should be noted that in 1980 almost 80 percent of these costs were attributed to clients with primary alcohol problems (Harwood et al. 1984). Although it appears that the proportion of individuals in long-term residential alcohol and drug abuse treatment who had alcohol problems (counting primary alcohol plus combined alcohol and drug) declined from 80 percent in 1980 to almost 70 percent in 1991, it is difficult to attach broader significance to this finding. There have been major institutional changes in the organization, delivery, and financing of alcohol and drug abuse treatment as well as changes in prevalence patterns over the period of concern that obviate facile interpretation.
Patients spent almost 6.9 million days (18,800 patient-years) in hospitals in 1992 for treatment of alcohol and drug abuse and related health problems (see chapter 4 for the calculations and discussion). Again, this represents a loss of potential productive time, which can be assigned a value in the same manner applied to patients served in long-term residential substance abuse treatment facilities. For simplicity, the assumption is being made that the demographic characteristics of those in hospitals receiving treatment related to alcohol and drug problems were similar to characteristics of those served in residential specialty facilities, with an opportunity cost of their time equal to $35,000 per year. This yields estimated costs of $757 million for 1992, with $502 million for alcohol abuse and $255 million for drug abuse based on the diagnoses associated with care delivered in hospitals.