A note prepared for the International Working Party on Substance Abuse.

Keywords: Health;

Introduction

While considerable progress has been made on measuring the social costs of substance abuse, the question of how to deal with the ‘irrationality’ of consumers has not yet been resolved.

The incorporation of irrationality into actual behaviour does not come easily to economic theory, which traditionally has assumed that consumers are always rational. In recent years however, there as been a characterisation of consumer behaviour which involves time- inconsistency in their decision making.

This paper explores the implications of this characterisation for the measurement of the social costs of substance abuse, and thereby suggests a resolution to the problem of the extent to which the costs incurred by the substance abuser to her or himself should be included in aggregate social costs. The proposed resolution involves an analytical framework, together with the use of an empirical parameter, the estimation of which is hardly discussed here.

Rationality in Consumption – the Standard Account

There is a standard account in economics of how consumers make decisions which involve effects through time. At a very simple level it goes like this.

Each consumer faces a choice between two streams of net benefits reflecting different two different options. In one option the stream might be
b0, b1, b2, b3, …. bi …,

Where bi is the net benefit (benefits less costs) in the ith period.
and the other might be
c0, c1, c2, c3, … ci ….

Note the some of the elements may be negative, that is in a particular time period the costs may exceed the benefits.

In order tho choose between the options the consumer calculates
(1) B = Σbi/d^i
and
(2) C = Σci/d^i
Where
– in each case i is summed from 0 to infinity.
– d is a discount rate (often characterised by 1+r) which reduces the value of future costs and benefits in proportion to the time they are away from the present. Notice that 1/d<1, so the consumer is likely to give little weight to the effects in ten years time, and even less to those in twenty years time.

The rational consumer in the theory then choses the option (either b or c) based on which of B or C is the larger.

It would be foolish to assume that individuals are as calculating as this. However, the basic notion of their taking into considerations of all the costs and benefits to them, but giving less (in a systematic way) weight to costs further in the future seems to be a reasonable characterisation of most people’s behaviour most of the time.

This behaviour is usually called ‘economically rational’.

Irrationality and Time-Inconsistency

In order to give an intuition of the phenomenon being discussed, consider a three period situation where in the first period the individual plans their consumption of alcohol in the second period, and potentially suffers a consequence, say a hangover, in the third. Suppose in the first period, the individual decides that they will confine themselves to, say, three glasses in the second period, thus avoiding a hangover in the third period. However, very often the actual consumption is, say, six glasses and the individual suffers a roaring hangover, laced with the regret that if only they had kept to their first period drinking to plan.

Economists label this ‘time- inconsistency’ which can be defined as situations where, with the passing of time, policies that were determined to be optimal (yesterday) are no longer perceived to be optimal (today). That applies between the first and second period of our example.

Because such terms as ‘rationality’ and ‘irrationality’ and ‘addiction’ are used rather loosely, while there are technical terms like ‘rational addiction’, it is proposed to hereafter call this behaviour ‘time- inconsistency’ and leave others to decide whether it si rational or irrational, or addictive.

This time- inconsistency can be modelled with ‘hyperbolic discounting’ proposed by David Laibson (1997). A simpler algebraic presentation will do for our purposes.

Suppose the net benefit in one course of action, say the restrained drinking, in each of the three periods is b0, b1, b2 (as judged by the consumer), and the other course, the greater imbibing, is c0, c1, c2. Since in our example b0 and c0, incurred while they are planning ,are the same, they may be taken as zero. The second period net benefits (including the offset for the financing of the drinking) b1 and c1 are both positive with c1 the greater because consumption is higher. We assumed that b2 was also zero, there being no hangover or other subsequent costs from the restrained drinking of the earlier period. However c2 is negative.

So the decision-maker faces two streams: cautious drinking (0, b1, 0) and higher imbibing (0, c1, -c2). In the first period the decision-maker does the standard discounting. of the flows and calculates the net benefit of the first option is b1/d and c1/d-c2/d2. (Where, we use, for simplicity ‘d ‘as the discount factor). Since the individual plans the more restrained option we know

(3) b1/d > c1/d – c2/d2
or
(4)b1 > c1 – c2/d.

In the second period the decision-maker faces (b1, 0) and (c1, -c2) which gives exactly the same decision. If b1 > c1 – c2/d, then the choice will remain the restrained consumption. There is time- consistency: the policy chosen in period 1 remains the policy chosen in period 2.

However, sometimes the individual chooses the high consumption option.

So we have to modify the analysis. Perhaps the simplest form of the hyperbolic discounting involves an adaption of the standard discounting rule from
(5 – ie.e (1)) maximise Σbi/d
to
(6) maximise b0 + βΣbi/d.

where β <1. (Were β=1, it would be the time- consistent formula again.)

What is happening is that when making the decision the individual devalues future costs and benefits relative to those in the decision period (above that of standard time- discounting). The smaller the β the less notice is taken of the future consequences of a current decision.

Apply this to the simple example we looked at earlier.

From the first period perspective equation 1 becomes
(7) βb1/d > βc1/d – βc2/d2
which remains as for equation 4..
(8) b1 > c1 – c2/d.
So exactly the same decision is made as in the time- consistent case.

In the next period the sequence (b1, 0) is valued as b1, but the sequence (c1, -c2) is valued as c1 – βc2/d, which is larger than c1 – c2/d.

The decision inequality is no longer (8), but b1 against c1 – βc2/d so that now it is possible (say β = 0) that
(7*) b1 < c1 – βc2/d.
so the consumer would abandon the restrained drinking option, and imbibe more generously. Thus the consumer exhibits time- inconsistency.

This analysis is being applied in many areas of consumer behaviour, including the case for higher sales taxes where such behaviour occurs, demonstrating they may generate a gain in consumer welfare. (O’Donoghue & Rabin, 2003) However, as far as is known, nobody has yet considered its relevance to estimating the social costs of substance abuse.

The Social Costs of Substance Abuse When there is Time-Inconsistent Behaviour

When the social costs of substance abuse is being estimated, one of two options are typically preferred in regard to the costs imposed by the consumption on the consumer. The first is that any costs that a substance abuser causes to her or himself is included in their rational calculation during the consumption decision, and therefore should not be included in social costs since it is offset by the benefit the consumer gets from the consumption. The best known proponent of this view is Gary Becker. (His 1988 paper with K. Murphy defends this view based on rationality but introduces the notion of rational addiction).

The alternative approach has to be to include all the costs incurred by the substance abuser after the consumption (that is excluding the purchase price).

Which is the more correct?

Suppose there is the time- inconsistent behaviour and the consumer takes into consideration only β of the future costs to her or himself. They ignore (1-β) of those costs in their calculations.

This suggests that this (1-β) of the costs should be included in the social costs of substance abuse, because just like the costs to other people, to businesses and to the public sector they are ignored when the consumption decision is made and are not offset by any benefits that the consumer gains from the use.

We can see that those who are arguing that none of the costs which a consumer imposed upon themselves should be included in net social cost, are assuming that β = 1 and there is no time-inconsistency. Conversely, those who argue that all of the costs should be included are arguing that β=0, and there is total time-inconsistent behaviour.

Thus what appears to a be a theoretical dispute proves to be an empirical one, the size of β.

Applying the Consequences of Time-Inconsistent Behaviour to Social Cost Estimates

In the following I am going to assume that the economist’s description of addiction is acceptable to sufficient specialists in the addiction field. Behavioural economics is based on economists’ understanding of the psychological literature. Even so, I have not seen a lot of non-economics expertise supporting it.

In some respects the above resolves a theoretical dispute by showing it is an empirical dispute by proposing to bell the cat. The tough job still has to be done. What are the β?

Note that we are considering only the application of the β to the personal costs to the substance abuser (including sickness and death as well as financial layouts). The costs to others, to businesses and to the government are to be treated exactly as they are recommended in such guideline as Single et al (2000) and Collins et al (2005)

In the current state of knowledge, the best we might get to a guidelines. The following is intended to be indicative – a basis for discussion. Empirical evidence to support some conclusions needs to be scouted out. The last section discusses how to deal with development of addiction.

Narcotics

Perhaps it will be recommended that β = 1 for narcotics, that is the abuser completely discounts the costs incurred. This is an extreme assumption. One could imagine a mild abuser whom we would not call an addict, making calculated assessments of the effects of their consumption including subsequent harm. However since such harm is likely to be small, β is probably very close to unity.

Alcohol

Many people consume alcohol with their β equal to or near equal to unity. But they probably dont cause a lot of damage to themselves. (How much?) What we need is an estimate of the βs for those who consumption leads to significant damage to themselves. It would be easy to assume that for them β = 0, that is they completely ignore subsequent costs when they are drinking. That may be true for some, but is probably not true for everyone (as when one takes just one more than is ‘good’ for one). Note too the relevant β is not the average for addicted drinkers but the average weighted by the self-damage they cause which is likely to be nearer to zero. Probably the required β is very low, but how low?

We need a panel of experts to make an assessment. What empirical evidence might help them?

Tobacco

Unlike alcohol, all smoking of tobacco is self damaging, although because of the damage to the heart (and perhaps for other medical conditions) the damage on average depends upon the age of the smoker.

We also have got past the stage that smokers can claim ignorance of the consequences of their smoking. There may be some – perhaps the very young – and there may be some dangers of which we are not yet aware. But the anti-tobacco/public health campaigns have sufficient effect that the message that smoking is damaging to one’s health is broadly understood by the vast majority of smokers.

More problematic is that much of the damage is some distance in time off. An ordinary discount rate may reduce the significance of the damage to a rational addict so they continue to smoke. We probably need to think more carefully about how this impacts on the social cost measurement. It may differ between the two standard counterfactuals which lead to either avoidable costs or total cost calculations.

But even ignoring this time dimension, there remains the problem of assessing an appropriate β.

When surveyed many, but not all, smokers regret they smoke, saying they would like to give it up. Presumably those smokers have lower βs than unity (although not necessarily zero). But what about those who say they have no regrets? Are their βs unity or are they showing bravado?

And how do we deal with the young? If the costs are low (as on their hearts) or a long way away they might smoke with a β of unity, even though later they incur considerable costs (say cancers precipitated years earlier). The next section discusses a further complication.

It is not evident from this that the relevant aggregate β is close to zero. Again we need a panel of experts to make an assessment. What empirical evidence might help them?

Consuming which Generates Addiction

Currently most behavioural economics assumes the β is given for each individual.

But practically we know of people who start off as non-addicts (β=1) and become addicts (β<1, even 0). It is not hard to envisage that the value of β depends upon past consumption either in terms of aggregates of some nonlinear function where intensity (consumption per unit time) is important.

For instance young people who have never smoked are not addicted to tobacco. As they smoke (presumably discounting the low likelihood of heart disease and the distant likelihood of cancer) many become addicted, their β falling below unity. How do we incorporate that behaviour into the personal costs they generate? Obviously we need to model the phenomenon more precisely than these paragraphs (and the modelling may lead to insights of how to better deal with the young’s pre-addictive behaviour).

And then there will be the task of incorporating the insights into these models, no doubt with some empirical evidence to guide us on the parameters.

Conclusion

Science generally develops by incremental steps. This paper has clarified the dispute between those who want to incorporate all personal costs from substance abuse into social costs estimates and those who argue that none should be included. It has shown that the true response depends on a parameter β which lies between zero and unity which reflect the two extremes of the dispute (and perhaps on some other parameters). However despite the progress, there is much theortical and empirical work to be done.

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Draft for “The International Encyclopedia of Public Health” (2008) vol.1 pp.112-116.

Keywords: Health; Regulation & Taxation;

Depending on the cultural context and particular circumstances, the same drink of alcohol can generate a feeling of benign prosperity, or moroseness, or stupor. The immediate health benefits for the individual may also be benign (or even beneficial), or the drink may result in injury or death – in the short run from accident or in the long run from one of the diseases alcohol can precipitate. The consequences for others may also be benign or beneficial, or damaging or mortal from violence or collateral accident. Someone may be born as the result of intentional or unintentional impregnation. The loss of production due to poorer workplace productivity or non-attendance from drinking alcohol may cause financial loss to the drinker and possibly to others. Among the many sectors of the economy alcohol may, or may not, especially generate additional costs in the criminal system, in the health system, and in the transport system. The national budget probably gains from the specific tax it levies on alcoholic beverages, but these levies may, or may not, cover its costs from the consumption of alcohol.

The impact of alcohol consumption is so multifarious that it is not easy to track all its social and economic impacts. This review confines itself to the ones which ‘social costs of alcohol misuse’ studies have paid most attention to, excluding the burden of disease caused by alcohol which is covered in this volume by Rehm. The framework used is that of the WHO report International Guidelines for Estimating the Costs of Substance Abuse, and related and subsequent studies although some of the technical issues such as the valuation of life, counterfactual hypotheses, and discounting are not considered here,

As the opening sentence reminds us, the social and economic impact of alcohol is affected by the cultural context, even though the physiological impact may not be. This means that each country, or culture within a country, has its own quantitative and qualitative particularities. This entry deals with the heterogeneity by its bibliography including recent country specific studies (especially cost studies, because they look at most dimensions of the impact).

Following brief discussions on externalities and irrationality, the main areas of impact are dealt with in alphabetical order, because their relative significance will vary from country to country.

Externalities

The social cost of an activity is the total of all the costs associated with it, including both the costs borne by the economic agent involved and also all costs borne by society at large. This includes the costs reflected in the organisation’s charge (price) which covers the use of the various resources (including labour capital and risk as well as natural resources) excluding taxation, together with the costs external to the firm’s private costs. If social costs are greater than private costs – the costs of purchase – then a negative externality is present.

When the market economy is working effectively, and there are no external social costs, rational consumer will only purchase and consume the product if it is more valuable to them than the price paid for it. In this case society is better off since the consumers deem themselves better off from the transaction, and society is no worse off since it has traded off the social costs of the consumption for the payment which embodies the ability to purchase other products with equivalent social costs.

There are all sorts of subtle assumptions embodied in this analysis: public health analysis often worries about the equity in the distribution of income – the power to purchase. But even if those assumptions hold (near enough), alcoholic beverages are one of a number of products for which the purchase price cannot generally equal social costs because the social cost of each unit of consumption varies greatly. Thus the social cost of the first drink in a session may reflect the private cost, but later drinks may generate additional social costs in poor health, material damage, public and private outlays which were ignored when the drinking decision was made, violence to others, and even death to the drinker or, in the case of motor vehicle accidents and the like, to innocent bystanders.

As a later section discusses, taxation and other public policy measures aim to reconcile in one way or another the inconsistency between the purchase price and social costs. However there is still likely to be a substantial difference for at least a number of significant ingestions.

A useful term is ‘misuse’ for where the consumption generates outcomes which were unintended by the consumer and not taken into account when the purchase/drinking decision was made. It is sometimes preferred to ‘abuse’ in order to emphasise, that much alcohol consumption is useful, in the sense of its social impact is benign or even (mildly) beneficial.

Irrationality

The previous discussion has assumed that consumers are acting rationally, taking into consideration all the costs of the consumption which affect them (although they may discount costs in the more distant future).

However, it is not immediately obvious that ‘rationality’ applies when there is drunkenness or addiction. Economists explore this use a theoretical definition of irrationality where consumers show time inconsistency between decisions, as when they go into a bar to have three drinks, change their minds as a result of the resulting euphoria and drink more, and the following day regret the change of mind. Ainslie (1992) Frederick, Loewenstein, and O’Donoghue (2002) O’Donoghue and Rabin (2003).

It is unclear how to define externalities in such circumstances. The tendency has been to ignore such irrationality, but increasingly cost of alcohol studies need to address it, incorporating it in a rigorous way consistent with the theory.

Crime

Pernanem et al (2000, 2002), based on Goldstein (1985), proposes four models (‘modes’ might be a better word) to account for alcohol associated crime.

1. The pharmacological model in which intoxication encourages the commission of crimes which otherwise would not have been committed.
2. The economic means model in which crimes are committed to fund alcohol consumption.
3. The systemic model involving the illegal economy, as in unlawful brewing or distilling or sale of liquor.
4. The substance-defined model, where actions are defined as being criminal by laws which regulate drug use, such as drunkenness in a public place, supplying underage or drunk people (if that be illegal) and drink-driving.

Note these apply also to illicit drugs, where that modes 3 and 4 are more important than to alcohol.

This crime causes social costs, both directly via damage to property and individuals but also with consequent costs to the public purse for policing, justice and corrections, transport management and indirectly when it adds to concerns about community safety and security.

Estimating the attributable fractions (the proportions which alcohol causes) for criminal activity is much less advanced than for disease. Because law, practices of enforcement and culture vary by country, fractions cannot be easily borrowed from other jurisdictions. (Indeed care is also required in generalising research findings on the relationship between crime and alcohol.)

Diseases (Drinkers)

Rehm (2006), this volume, describes the impact of the consumption of alcohol on the health of the consumer.

As well as affecting the health of its drinkers, alcohol can affect the health of others. These include:
1. Children born as the result of an unplanned conception as a result of intoxication. (It is not obvious how to deal with this.);
2. Those suffering Foetal Alcohol Syndrome and Foetal Alcohol Effects, said to be the major source of mental illness and behavioural disorders, and generating on average a large public cost during their life time; Harwood (2000)
3. Those close to the drinker who may experience pain and suffering, abuse, violence, injury and death;
4. The public at large who may experience pain and suffering, violence and death including from motor vehicle accidents.

There are rarely good estimates of these phenomena, and the incidence and costs vary from country to country.

Motor Vehicle Accidents

As well as injury and death from motor vehicle accidents caused by alcohol consumption there is damage to the cars and property, the costs of law enforcement and prevention (which may include road design), and the costs of administrating the insurance system. (There are also costs in the resulting travel delays).

Motor vehicle accidents are particularly onerous, but there are other accidents. Industrial accidents caused by alcohol are usually covered in the next section.

Production Losses

Drinking alcohol may result in production losses from the
1. Reduced workforce size as a consequence of death or premature retirement;
2. Absenteeism from sickness or injury;
3. Reduced on-the-job productivity from sickness or injury and accidents.

Alcohol misuse may also cause loss of production in the unpaid household sector and in other non-market activities. Although the informal economy is not included in the standard measures of market output (such as GDP or GNP) the losses or production in it due to alcohol misuse may be significant.

Public Spending

Most of the above events described above, to some extent impact on public spending (or, for those countries which depend more upon private provision, on the private insurance system). Such an impact is a classic externality, because it is unlikely to be taken into account by the drinker.

Among the most significant sectors affected by additional spending are costs to the health system (at every level from prevention to advanced tertiary specialities, but also for nursing care later in life). social security or other forms of public income maintenance, traffic management, and also to policing, justice and corrections.

Taxation and Public Policy

Historically, specific taxes on alcohol were imposed because they could be readily collected at brewery, distillery or port. (There are greater difficulties collecting excise from small vineyards.) Later in some, but not all, jurisdictions the justification for special duties shifted from convenience to a notion of the propriety of taxing ‘sinful’ activities.

More recently, in some jurisdictions, alcohol taxes have been justified by the arguments that raising the cost of alcohol better reconciles the private cost and social cost of alcohol consumption. If so, the pure logic might conclude that the level of taxation should be related to the quantity of absolute alcohol rather than the value of the drink, imposing more heavily on low value drinks. An extension would be to focus on the minimum cost of alcohol, structuring the excise to maintain a minimum cost of absolute alcohol, where some of the worse social costs occur. Easton (2002).

However no country has an economically rational alcohol taxation regime, and revenue considerations still remain important in its design as well as political and cultural considerations.

Moreover, as previously mentioned, the divergence between private and social cost varies from drink to drink, so a taxation regime cannot be perfect. Thus other public policy measures have to be implemented. See 355 Effective Alcohol Policy and 366 Integrated Alcohol Control, this volume.

Insofar as such policy measures are effective, there would be a reduction in the divergence between private and social cost, and the optimal excise duty is lower than if the policies are ineffective.

Conclusion

The impacts of alcohol consumption are manifold, and it is not practical to list them all. The ones discussed here are generally those which are known to be largest in quantifiable terms, as measured by their impact on GDP (or GNP) the standard measure of the aggregate output produced in the formal economy (generally valued at market prices). It asks what of the available production had to be diverted to deal with the costs of alcohol misuse. (Technically it is an estimate based on supposing that alcohol misuse had not occurred, what additional resources would have been available for consumption and other purposes.)

The table below provides estimates for a couple of countries of this (tangible) ‘social cost of alcohol’, as a proportion of GDP. The estimates come from studies which broadly conform to the International Guidelines. Single et al, 2002. They do not include estimates of the intangible costs, arising from death injury and poor quality life which alcohol misuse generates (avoiding, among other things, the problem of valuing of life). Nor do they include the impact on the informal economy, because there is no measure of the aggregate value of its output (the equivalent of GDP).

The (Tangible) Social Costs of Alcohol as a proportion of GDP

In each case the costs are estimated to be near 1 percent of GDP, the implication being that without alcohol misuse effective GDP would be 1 percent greater. However the increase in GDP per capita would be lower, depending on the mortality impact on the population.

Note that despite using the same international guidelines, there are considerable differences between the subtotals, only some of which may be explained by classification differences or by the different cultures and institutional arrangements of Australia and Canada..

Nevertheless, while other countries may have different social costs of alcohol misuse, representing the waste from drinkers not taking into consideration the social consequences of their decisions, the magnitude as a proportion of total output is likely to be significant. The quantification reinforces the common sense conclusion of a need for behaviour change and public policies in regard to alcohol consumption in order to reduce its misuse.

Bibliography
Ainslie, G. (1992) Picoeconomics, Cambridge: Cambridge University Press.
Andlin-Sobocki P. and Rehm J. (2005), “Cost of addiction in Europe”, European Journal of Neurology, 12(s1): 28-33.
Babor, T. Caetano, R. Casswell, S. Edwards, G. Giesbrecht, N. Graham, K. Grube, J. Gruenewald, P. Hill, L. Holder, H. Homel, R. Österberg, E. Rehm, J. Room, R. and Rossow, I. (2003), Alcohol: no ordinary commodity. Research and public policy, Oxford and London; Oxford University Press.
Collins, D.J. and Lapsley, H.M. (2002), Counting the cost: estimates of the social costs of drug abuse in Australia in 1998-9, Canberra, National Drug Strategy Monograph Series No. 49,
Collins, D. Lapsley, H. Brochu, S. Easton, B. Perez-Gomez. A. Rehm, J. Single, E. (2006) International Guidelines for the Estimation of the Avoidable Costs of Substance Abuse, Ottawa, Canadian Centre on Substance Abuse.
Easton, B. (1997), The Social Costs of Tobacco Use and Alcohol Misuse, Public Health Monograph No. 2, Department of Public Health, Wellington School of Medicine.
Easton, B. (2002) Taxing Harm: Modernising Alcohol Excise Duties, Wellington, Alcohol Advisory Council of New Zealand,
Elster, J. (ed) (1999) Addiction: Entries and Exits, New York: Russell Sage Foundation.
Frederick, S. Loewenstein, G. and O’Donoghue, T. (2002) Time discounting and time preference: A critical review, Journal of Economic Literature Vol. XL June 2002: 351–401.
Gmel, G, Rehm, J. Room, R. and Greenfield, T. (2000) Dimensions of alcohol-related social and health consequences in survey research, Journal of Substance Abuse 12:113-138.
Goldstein, P.J. (1985). The drugs/violence nexus: A tripartite conceptual framework, Journal of Drug Issues, 14, 493-506.
Harwood, H. (2000). Updating estimates of the economic costs of alcohol abuse in the United
States: Estimates, update methods, and data, Report prepared by the Lewin Group for the National Institutes on Alcohol Abuse and Alcoholism, Washington.
Haworth, A. And Simpson, R. (2004) Moonshine Markets, New York and Hove: Brunner Routledge.
Heather, N. Peters, T. and Stockwell, T. (eds.) (2001) International Handbook of Alcohol Dependence and Problems, Chichester: John Wiley & Sons.
Huakau, J. Asiasiga, L. Ford, M. Pledger, M., Casswell, S. Suaalii-Sauni, T. and Lima, I. (2005) New Zealand Pacific peoples’ drinking style: too much or nothing at all? New Zealand Medical Journal 118:1491-.
Klingemann, H. and Gmel, G. (eds.) (2001) Mapping the Social Consequences of Alcohol Consumption, Dordrecht: Kluwer Academic Publishers.
Mathers, C. Bernard, C. Iburg, K. Inoue, M. Fat, D. Shibuya, K. Stein, C.; Tomijima, N. and Xu, H. (2003) Global Burden of Disease in 2002: data sources, methods and results, Global Programme on Evidence for Health Policy Discussion Paper No.54, Geneva, World Health Organization,
O’Donoghue, T, and Rabin, M. (2003) Studying Optimal Paternalism, Illustrated with a Model of Sin Taxes, American Economic Review Papers and Proceedings 93(2), May 2003: 186-191.
Pernanen, K. Brochu, S. Cousineau, M.-M. Cournoyer, L.G. and Fu Sun (2000), Attributable fractions for alcohol and illicit drugs in relation to crime in Canada: conceptualization, methods and internal consistency of estimates, Bulletin on Narcotics, Volume LII, Nos. 1 and 2, United Nations Drug Control Programme.
Pernanen, K. Cousineau, M-M. Brochu, S. and Fu Sun (2002), Proportions of Crimes Associated with Alcohol and Other Drugs in Canada, Ottawa, Canadian Centre on Substance Abuse, www.ccsa.ca/docs/crime2002.pdf.
Österberg, E. and Karlsson, T. (eds) (2002) Alcohol Policies in EU Member States and Norway: A Collection of Country Reports, Helsinki, STAKES.
Rehm, J. (200?) The Burden of Disease Caused By Alcohol,” This volume.
Rice, D. Kelman, S. Miller, L. Dunmeyer, S. (1990) The Economic Cost of Alcohol and Drug Abuse and Mental Illness, 1985, DHHS Publication No. ADM90-1694, San Francisco: Institute for Health and Ageing, University of California.
Room, R. Babor, T. and Rehm, J. (2005), “Alcohol and public health”, Lancet, 365(9458): 519-30.
Single, E. and Easton, B. (2001), Estimating the economic costs of alcohol misuse: why we should do it even though we shouldn’t pay too much attention to the bottom line results, paper presented at the annual meeting of the Kettil Bruun society for Social and Epidemiological research on Alcohol, Toronto, May.
Single, E. Collins, D. Easton, B. Harwood, H. Lapsley, H. Kopp, P. and Wilson, E. (2003), International Guidelines for Estimating the Costs of Substance Abuse-Second Edition, Geneva, World Health Organisation.
Single, E. Robson, L. Xie, X. Rehm, J. (1998) The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992, Addiction 93:7: 983-998.
Skog, O.J. (1985), The collectivity of drinking cultures: a theory of the distribution of alcohol consumption, British Journal of Addiction, 80(1): 83-99.To be added.
355 Effective Alcohol Policy, this volume.
366 Integrated Alcohol Control, this volume,

Acknowledgements
Serge Brochu, David Collins, Mike MacAvoy, and Pierre Kopp all commented on an early draft of this entry.

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