Identifying the impact of the business cycle on drug-related harms in European countries.

BACKGROUND: The evidence resulting from the analysis of the association between economic fluctuations and their impact on the substance use is mixed and inconclusive. Effects can be pro-cyclical (drug-related harms are predicted to rise when economic conditions improve), counter-cyclical (drug-related harms are predicted to rise in bad economic times) or unrelated to business cycle conditions as different transmission mechanisms could operate simultaneously. METHODS: The main aim of this study is to assess, from a macroeconomic perspective, the impact of economic cycles on illegal drug-related harms in European countries over the 2000-2020 period. To this end, the regime-dependent relationship between drug-related harm, proxied by unemployment, and the business cycle, proxied by overdose deaths will be identified. Applying a time dynamic linear analysis, within the framework of threshold panel data models, structural-breaks will also be tested. RESULTS: The relationship between economic cycles (proxied by unemployment) and drug-related harms (proxied by overdose deaths) is negative, and therefore found to be pro-cyclical. One percentage point in the country unemployment rate is predicted to reduce the overdose death rate by a statistically significant percentage of 2.42. A counter-cyclical component was identified during the 2008 economic recession. The threshold model captures two effects: when unemployment rates are lower than the estimated thresholds, ranging from 3.92% to 4.12%, drug-related harms and unemployment have a pro-cyclical relationship. However, when unemployment rates are higher than this threshold, this relationship becomes counter-cyclical. CONCLUSIONS: The relationship between economic cycles and drug-related harms is pro-cyclical. However, in situations of economic downturns, a counter-cyclical effect is detected, as identified during the 2008 economic recession.

Expenditure on the treatment of drug and alcohol disorders in hospitals: How much and what explain it?

BACKGROUND: The role of hospitals in providing treatment for drug and alcohol abuse varies markedly across countries. Knowing public expenditure on drug treatment in hospitals is an essential input for any cost-effectiveness and policy analysis. However, information on the level and trend in spending is often unavailable. This study aims firstly to estimate the expenditure on hospital treatment for illicit drug and alcohol use as primary diagnoses across Europe for the 2013-2015 period, secondly to explain recent expenditure trends and lastly to analyse their impact on policy. METHODS: The study uses annual health expenditure data from Eurostat which complies with the 'System of Health Accounts' framework and covers the countries of the European Union as well as Norway. Data on hospital activities exist for 'Mental and Behavioural Disorders', which includes a breakdown into disorders caused by the use of alcohol and other psychoactive substances. The study uses 'attributable fractions' to estimate the proportion of hospital expenditure allocated to drug and alcohol treatments, based on data about this activity. Last, but not least, a panel data approach for the 2006-2015 period is used to explain expenditure determinants. RESULTS: In 2015, it is estimated that EUR 5.8 thousand million and EUR 2.9 thousand million were spent on the treatment of alcohol and drug disorders in hospitals as primary diagnoses, respectively, for a set of 24 European countries with available data. Cross-country differences can be explained by the level of income, the burden of disease and the structures of health systems - for instance, the proportion of public spending and the level (or share) of resources allocated for outpatient care. CONCLUSION: These estimates allow a better evaluation of treatment provision and, therefore, a better allocation of scarce resources. This information can support service providers, health policymakers and taxpayers. In this sense, it is a first step in developing policy evaluation and cost-effectiveness analysis.

Unemployment and drug treatment.

BACKGROUND: Since 2007 the economic recession has hit most industrial countries and this raises the question of how economic hardship affects illicit drug users' decisions to enter drug treatment. METHODS: We test the hypothesis that an improvement in the employment prospects, as measured by a decline in unemployment, strengthens the intrinsic motivation of an unemployed drug user to enter treatment. Our hypothesis is that the "payoff" of entering treatment increases when the unemployed drug user has a greater probability of finding a job. We reviewed the literature and found considerable evidence to substantiate this effect. We tested the hypothesis econometrically using two different data sets, one EU-wide and one German data set. RESULTS: Our main findings were that unemployment has a significant negative effect on the number of drug users entering treatment, i.e. when unemployment declines (increases) the number of drug treatment clients increases (declines). We also found that unemployed drug users entering treatment are most sensitive to variations in the economy-wide unemployment rate. Employed drug users, in contrast, are not influenced by these variations when deciding to enter treatment. CONCLUSION: Our empirical results confirm that the creation of job prospects adds significantly to the willingness of unemployed drug users to enter treatment. This lends support to the idea that drug treatment should be embedded in programmes to improve the job prospects of drug users.