Why we should still estimate the costs of substance abuse even if we needn't pay undue attention to the bottom line.

A coalition of provincial, national and international addictions agencies has sponsored a series of symposia leading to the developing of international guidelines for estimating the costs of substance abuse. These guidelines have now been used in national studies in four continents, with more consistent and comparable results than in previous studies. Although the bottom-line results have been used to argue for alcohol and drug issues having a higher place on the public policy agenda, the real value in such studies lies in the detailed results regarding mortality and morbidity attributable to substance abuse, the relative contribution of acute versus chronic conditions to overall problem levels and the role of substance misuse in adverse social consequences, such as crime and economic productivity. There is a variety of factors which undermine the robustness of the findings, including lack of data, layering of assumptions and changes in the epidemiological knowledge base. It is argued that economic cost estimates should nonetheless be conducted and continually refined, as the detailed findings are of great utility to the design and targeting of prevention programming and policy. The presentation concludes on a personal note of farewell, as this is the author's final conference presentation.