Aim, Design and Setting: The economic costs of alcohol, tobacco and illicit drugs to French society are estimated using a cost of illness framework. Measurements: For the cause of disease or death (using ICD-9 categories), pooled relative risk estimates from meta-analyses were combined with prevalence data by age and gender to derive the proportion attributable to alcohol, tobacco and/or illicit drugs. The resulting estimates of attributable deaths and hospitalizations were used to calculate the associated health care, law enforcement, productivity and other costs. The results were compared with those of other studies, and sensitivity analyses were conducted by alternative ways of measuring risk attribution and costs. Findings: The use of alcohol, tobacco and illicit drugs cost more than 200 billion francs (FF) in France in 1997, representing 3,714 FF per capita or 2.7% of the gross domestic product (GDP). Alcohol is the drug that gives rise to the greatest cost in France, i.e. 115,420.91 million FF (1.42% of GDP) or an expenditure per capita of 1,966 FF in 1997. Alcohol takes more than half of the social cost of drugs to society. The greatest share of the social cost of alcohol comes from the loss of productivity (57,555.66 million FF), due to premature death (53,168.60 million FF), morbidity (3,884.0 million FF) and imprisonment (503.06 million FF). Tobacco leads to a social cost of 89,256.90 million FF, that is an expenditure per capita of 1,520.56 FF or 1.1% of GDP. Productivity losses amount to 50,446.70 million FF, with losses of 42,765.80 million FF as a result of premature death and 7,680.90 million FF linked to morbidity. Health care costs for tobacco occupy second place at 26,973.70 million FF. Illicit drugs generate a social cost of 13,350.28 million FF, that is an expenditure per capita of 227.43 FF or 0.16% of GDP. Productivity losses reach 6,099.19 million FF, with 5,246.92 million FF linked to imprisonment and 852.27 million FF to premature death. The cost of enforcing the law for illicit drugs occupies second place at 3,911.46 million FF, followed by health care costs of 1,524.51 million FF. Conclusion: Substance abuse exacts a considerable toll from French society in terms of illness, injury, death and economic costs.

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