It has become standard practice in formal assessments of the social burden of an illness or harmful activity to translate the resulting disability and death into dollar figures. Underage drinking is no exception. For example, a recent report concluded that the cost of alcohol use by youth was $53 billion in 1996, including $19 billion from traffic crashes and $29 billion from violent crime (Pacific Institute for Research and Evaluation [PIRE]). If the costs of other consequences—such as low academic performance or medical costs other than those associated with traffic crashes—were quantified, it is possible that the cost would be even higher. Since numbers of this sort are potentially important in setting public priorities, it is worth understanding some of the controversies and practical difficulties in making such estimates (see Chapter 4; Cook and Ludwig, 2000; Cook, 1991).

It is natural to measure the burden of underage drinking in terms of the incidence of various consequences. As we have seen, those consequences include violent death, disability, disease, reduced academic and occupational achievement, and property damage, among many others. Estimating the causal role that underage drinking plays in each of these outcomes is the very big and difficult challenge for epidemiologists. But even with reliable estimates for the contribution of underage drinking for each consequence, one would be left with the question of how to sum them up. A summary statistic is useful in assigning relative priority to this particular problem in comparison with all the other problems requiring public attention. A summary statistic quoted in dollar terms is particularly useful because it lends itself to comparison with the budget costs of policies to remediate the problem.

What question is to be answered by the estimate of social cost? Ultimately the question is something like the following: “How much would Americans’ overall standard of living improve if underage drinking were somehow eliminated?” In the PIRE study (1999) it is noted that the “cost” of underage drinking, based on the given assumptions, equaled $530 per year for every household in the United States; the suggestion is that eliminating underage drinking would be the equivalent of adding that amount to average household income.

Of course in practice there is no way to entirely eliminate underage drinking. But the total cost is nonetheless of some interest as a guide to how underage drinking can be compared with, say, cancer or illiteracy or terrorism in setting national priorities. The total is also useful to the extent that a