May 18, 2022

Excessive drinking cost North Carolinians $9.73 billion – or $2.09 per drink – in 2017, according to research from UNC-Chapel Hill. This is a 38% increase over excessive drinking costs in 2010.

Experts say most of this rise in costs is likely from the 40% increase in binge drinking during these years; inflation explains just 12% of the change.

Alcohol is the most commonly used drug in North Carolina. Binge and heavy drinking (“excessive drinking”) can lead to diverse harms like breast and colorectal cancer, as well as injuries that impact others, such as motor vehicle crashes and violence. These outcomes carry a broad financial toll incurred by institutions ranging from hospitals to nursing homes, courts and workplaces.

A new study in the N.C. Medical Journal found that N.C. drinkers bore less than half the cost of excessive drinking, placing most of the financial burden on the government and people other than the drinker. The government picked up $4.43 billion of the tab, while excessive drinkers paid $3.36 billion and others paid $1.53 billion.

Katherine Gora Combs

Katherine Gora Combs

“The harms from excessive drinking can be hard to ‘see’ because alcohol plays a causal role in over 200 diseases and injuries. By measuring and adding these diverse outcomes on a common scale – dollars and cents – we were able to better illuminate the steep costs of excessive drinking,” said lead study author Katherine Gora Combs, MPH, a doctoral student in epidemiology at the UNC Gillings School of Global Public Health.

The research team combined methods from the 2010 National and State Costs of Excessive Alcohol Consumption Study and representative state-level survey data to adjust 2010 estimates of the financial impact of excessive drinking in N.C. to 2017. Their updates accounted for inflation and for changes in the number/percent of adults who binge drank and experienced alcohol-related outcomes. Their cost estimates catalog the financial burden of excessive drinking across three broad categories: healthcare costs, indirect productivity loss, and other costs like vehicular crashes, crimes and legal costs. Those costs were then allocated across three groups: drinkers, government organizations and people other than the drinker.

While indirect costs from harms like mortality, incarceration or impaired work productivity accounted for the highest financial burden, direct costs accrued a sizable burden. Many institutions commonly associated with alcohol paid large portions of these material costs, such as alcohol treatment centers and auto insurers.

However, other institutions that are often not readily associated with alcohol paid a significant portion of excessive drinking’s financial impact, such as prisons, jails, hospitals and health insurance administrations.

Dr. Pamela J. Trangenstein

Dr. Pamela Trangenstein

“In 2017, treatment centers and prisons paid more than $500 every minute of the year because of excessive drinking, while hospitals paid $430 every minute. This study makes plain that these institutions could protect their bottom line by helping prevent excessive drinking in NC,” said senior author Pamela Trangenstein, PhD, adjunct assistant professor of health behavior at the Gillings School and scientist at ARG.

The N.C. Institute of Medicine (NCIOM) has a target to reduce binge and heavy drinking from 17% in 2018 to 12% by 2030. This study demonstrates that this target potentially has positive fiscal consequences spread across the state by quantifying the growth in the cost of excessive drinking since 2010. In addition, these study results show that the NCIOM’s target could promote equity by reducing the financial burden bystanders need to spend because of the excessive drinkers in their lives.

“Policymakers could consider if this is the time to take our foot off the gas pedal when it comes to evidence-based alcohol policy,” said Trangenstein. “Rather than consider new policies that roll back restrictions on alcohol, policymakers may determine to consider new ways to help broad swaths of N.C. residents and institutions thrive economically.”

The study was led by epidemiologists at UNC, the N.C. Department of Health and Human Services (NC DHHS), and IQVIA and the Alcohol Research Group (ARG). Co-authors include Gora Combs; Michael Fliss, PhD, Gillings School graduate and research scientist at the UNC Injury Prevention Research Center (IPRC) and the NC DHHS Division of Public Health (DPH); Kendall Knuth, MPH, research associate at IQVIA; Mary Cox, MPH, substance use epidemiologist at DPH; and Trangenstein.

Read the full article online.

Contact the UNC Gillings School of Global Public Health communications team at

Visit our communications and marketing team page.
Contact with any media inquiries or general questions.

Communications and Marketing Office
125 Rosenau Hall
CB #7400
135 Dauer Drive
Chapel Hill, NC 27599-7400