It’s well-known that the disordered use of alcohol – formerly known as alcoholism, and now known as alcohol use disorder (AUD) – carries a heavy social and economic burden.
But what exactly causes that burden?
And does stopping alcohol use decrease costs, or does the cost of care remain roughly the same when a person with AUD stops drinking?
A study conducted in Finland in 2020 addressed these questions. Researchers used a Bayesian network – a type of predictive computer modeling – to assess the magnitude of the social and economic costs of alcohol use disorder, and whether remission has a significant impact on those costs.
Scientists at the University of Eastern Finland, Aalto University, and the Finnish Institute for Health and Welfare, looked at a total of 16 risk factors related to the economic impact of alcohol use. These included age, gender, marital status, employment, illegal drug use, criminal record, and history of drunk driving. The costs they examined included hospitalizations as well as outpatient visits. The study also looked at the effects when a person stops drinking. Remission was defined as a period abstinence or managed drinking that lasted at least 6 months.
Bayesian Networks and Probability
In probability theory, a Bayesian network is a method of graphical modeling typically used to compute a range of probable outcomes, representing interdependent probabilities on a directed graph. They are complex models that can incorporate various risk factors and analyze the causal relationships between them. These models help when predicting outcomes based on a number of interdependent variables, a key advantage for the Finnish researchers, since addiction and the disordered alcohol paints quite a complex picture. Many interrelated factors influence alcohol use disorder and its impacts on society. This method of probability modeling allowed the researchers to look at a complete picture and make predictions. The researchers also sought to assess the magnitude of costs associated with AUD.
Risk Factors and Relative Impact
The researchers examined data collected by Electronic Health Records in the North Karelia region of Finland between 2012 and 2016. Alcohol use disorder was defined for the purposes of the study to include harmful use as well as alcohol dependence – the current diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).
Their analysis found several factors that correlated with higher economic impact. Homelessness, drug use, and the number of psychiatric diagnoses all were associated with a significant increase in cost of care. Chronic conditions also played a huge role in the costs associated with alcohol use disorder, and the cost of care in patients with at least two chronic conditions were significantly higher than in patients without multiple diagnoses. The average cost of care for patients in that group was around 26,000 euros (roughly 30,000 USD) higher than those without chronic conditions.
This data shed light on various factors that can increase costs.
But what about patients in remission?
With so many other factors at play, the researchers wanted to determine whether costs actually decreased with abstinence.
Abstinence, the researchers found, lowered the costs significantly. Patients who stopped drinking dropped from the highest-cost group to the lowest quartile. The researchers concluded that effective treatment for alcohol use disorder had a significant impact on the economic costs of alcohol use disorder. They also concluded that in people with correlated risk factors such as chronic health diagnoses, a history of homelessness or drug use, or psychiatric diagnoses – the outcomes improved if the patient achieved remission and stopped using alcohol.
Assessing the Benefits of Rehabilitation and Access to Care
The data included in the study represented case histories of 363 individuals over five years – and only 20 percent of those individuals stopped drinking over that five-year period. Yet the reduction in cost of care for those patients was still significant.
These findings are helpful not only in assessing the complex picture of alcohol use disorder and its attendant costs, but also the benefits of providing treatment and care. Many patients who struggle with excessive alcohol use have other complicating factors – such as chronic health conditions, mood disorders, a history of drug use or homelessness – that increase their cost of care. But this study indicates that providing easy access to continued care and rehabilitation services would lower costs for those patients across the board.
The question remains: how relevant are these findings to the US?
Finland offers universal healthcare to all citizens, as opposed to the current American model of privatized healthcare. Finnish healthcare policies prioritize public health, preventive care, harm reduction, and health promotion. Nevertheless, the findings shed light on the interrelated nature of AUD and other diseases and social issues – and the study itself provides a model for assessing the true cost of treatment as well as the benefits of easy access to rehabilitative care.