1. Valuing the intangible costs of alcohol dependence A contingent valuation study Sonia Pellegrini Claude Jeanrenaud Institute for Economic and Regional Research University of Neuchâtel, Switzerland Financing mental and addictive disorders Venice - March 2005

2. Background 1.Direct costs: health care costs 2.Indirect costs: loss of production due to morbidity and mortality 3.Intangible costs: well-being losses Social cost of substance abuse 3 components:

3. Aim  To assess the impact of alcohol dependence on the well-being of the patients and their relatives, i.e. the so-called intangible costs.  Defined as : the loss of welfare, without any material consequences, that result from the addiction to alcohol.

4. Intangible costs of alcohol dependence  Addiction per se  Behavioural changes due to alcohol consumption Family life: neglect responsibilities, domestic violence Personal life: psychological distress (shame, anxiety) Professional life: absence from work, unemployment, disability Social life: limited social activities, marginalization Important psychological and physical suffering, for both the patients and their relatives

5. Method  Necessary to use a non-market valuation technique  The contingent valuation method is the only one that is sufficiently flexible to deal with such a complex good  CV relies on a hypothetical market to get an estimate of the value people place on a non-market good.  WTP is defined as the monetary equivalent of the loss of well-being incurred because of alcohol dependence

6. Scenario (simplified)  Imagine that a member of your household (husband, wife, children, parent) is dependent on alcohol.  Consider a new treatment that suppress all the symptoms of dependence and enables a quick return to a normal life.  Would like that your relative benefits from this treatment?  If yes, how much would you be willing to pay, monthly, in order that your relative could be treated?

7. Survey  July 2002, in the French speaking Switzerland.  Addressed to the general population, aged 18+.  236 face-to-face interviews, with a mean duration of 40 minutes.  Respondents selected according to quota sampling, based on sex, age and socio-economic status.

8. Descriptive results

9. Internal validity test

10. Intangible costs estimates  Represents the monetary equivalent of the well-being losses due to alcohol dependence; for the patients and their relatives.  Only encompasses alcohol dependence, even though abusers can generate similar costs.

11. Conclusion  The intangible costs of alcohol dependence are high compared to the direct and indirect costs direct + indirect costs = 1.5 billion €; intangible costs = 1.17 billion €  Ignoring the intangibles leads to a substantial underestimation of the burden alcohol imposes on society.  International guidelines should encourage taking intangible costs into account; methodological questions must be discussed.