According to the World Health Organization alcohol consumption per capita is expected to increase up until 2025 (5). The largest increase is expected in the Western Pacific (dominantly in the Chinese population). Estimates are that growth will be about 1.5 l of pure alcohol per capita. The increase is expected in the Americas and South-Eastern Asia too (5). All these changes will certainly have significant repercussions not only on the financial burden but also on physical and mental health and narrower and broader social consequences.

From the perspective of payers, cost estimation is very important. The starting point for health economic analysis and decision making requires consideration of not only cost but also outcomes.

Most health insurance policies in the EU and USA will not cover all alcohol abuse treatments or rehab expenses. Typically, there are always some out-of-pocket costs.

It is a simple calculation, considering that health insurance covers a shorter hospital stay – the treatment usually remains on that level. Short hospitalizations are not sufficient to enable a patient to achieve a stable psycho-physical condition, so the level of health care that a patient receives does not correspond to their real needs. This just leads to poor treatment outcomes, frequent relapses, repeated hospitalizations, and finally, to more costs (11). Also, it usually means that new relapses in a short period of time. These and similar situations are cause for a new cycle of problems with insurance.

The questions concerning alcohol abuse or problems associated with the cost of treatment and insurance are evaluated periodically, both in professional circles and in the media. According to the sources listed in the report by http://HBO.com, many people are struggling with substance addiction, as well as with the lack of treatment because of insurance limitations (15).

In fact, everything that relates to extended treatment is not covered by insurance as well as rehabilitation programs.

According to information from the same source, the economic share of untreated alcohol dependence is $325 billion per year. Also, if a person is adequately treated (adequate therapy and length of treatment), $7–$12 on every dollar spent are saved (16).

Despite calculation and everyday clinical practice, patient’s real needs are ignored by medical and other professionals. At the end, patients are faced with a closed circle.

The National Health Insurance Fund organizes the health-care system for all citizens and permanent residents, but with obligations for employees, self-employed persons, and pensioners to contribute. The wealthier members of society need to participate with higher percentage of their income, based on a specified sliding scale. This method of financing is a residue of the socialist system of health insurance, but in recent years, this system has undergone serious changes (harmonization with EU law).

For example, research results show that the total allocation for health amounted to 8.13% of the gross domestic product (GDP) in 2003, whereas in 2014, it amounted to 9.91% of the GDP. The share of foreign donations in health financing decreased from 1.7% of the GDP in 2003 to 0.46% in 2014. Within the public sector funders of health care in Serbia, it has been found that the predominant funder was the Republican Health Insurance Fund (NHIF) with a share of 91.2% in 2003 and 93.99% in 2014 (15, 17).

Although the financial commitment by the NHIF increased, it eventually became insufficient because of increased costs incurred as a result of the growing needs of the population. The average patient (often with good reason) is dissatisfied with health care and the fact that they have to wait for an “ordinary” ultrasound a month or 2, and up to a year for a MRI, while for many drugs, they have to pay 90% of the original price.

In EU countries, national health systems face different kinds of major financial challenges (18).

Many insurance companies, for example, in the UK, treat alcoholism as a disease. Of course, there are certain limitations concerning insurance. According to WHO sources, the maximum level of alcohol intake per week is 21 U for men and 14 U for women (1). In any case, insurance companies paradoxically do not require medical examinations for people who consume more than 40 U a week (an alcoholic unit is equivalent to half pint of beer or one glass of wine). It is questionable whether this kind of model reduces total treatment costs of patients suffering from alcoholism or increases it (19).

The Medical Report or record from a GP contains all the important information about the health condition of the patient.

Section from the medical record considering occasional drinking provides information about person’s average consumption. Data about dependents and marital status are included into family section. Employer section provides information not only about current employment and person’s responsibilities at work but also regarding possible alcohol intrusion. The insurance companies in UK are not obliged to contact the employer. Persons who have been diagnosed with alcoholism and currently drinking have a less chance to achieve a life insurance cover. On the contrary, recovering alcoholic with a significant abstinent period can get a good life insurance quote. The abstinence of a year or 2 is usually enough for a person to get an average price of life insurance. Furthermore, new consequent relapses could also be considered as potential aggravating factor to accomplish this kind of financial benefits.

The General Assembly of United Nations (UN) adopted in 1991. A wide-ranging set of provisions entitled “Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care.” According to Principle 4 of this important UN document (20, 21) (Table 1).

The stigmatization is more powerful than obeying the human rights. This applies to mentally ill individuals, or even more to addicts who are doubly stigmatized. In an attempt to initiate a more equitable access to treatment and affect inequality, in 2014, The International College of Person-Centered Medicine (the ICPCM) offered a new perspective of integrative health care oriented toward individuals and was formulated within the framework of the Geneva Declaration (20), which is as follows:

As global health challenges evolve, health care systems must include improved efforts to promote wellness, prevention, and effective chronic disease management. Health systems that fixate excessively on diseases and procedural interventions can lose sight of the person with the disease and the importance of that person’s life, family, and community. This has led to fragmentation of health care and has left most health care systems less effective and less efficient in achieving better population health outcomes. In many ways, the business of disease has overshadowed the provision of person-centered healthcare.

By analogy with the conclusion of a group of researchers proposed a new principle of health care, it can be said that all national health-care systems should be based on the principles of person-centered and community-based primary health care as a point of first contact of patients with the health-care system and the usual sources of patient care (20).

The heaviest burden of health risk and disease was observed in poor subpopulations of the poorest countries. The fact is that the people’s life chances varies not only because of poverty but also socioeconomic inequality. As part of the differentiation of society, numerous health problems that alcoholics have become more complicated as they go down the social scale (as they inevitably will, eventually), as well as more complex and more difficult to solve. Eventually, alcohol abuse leads to an escalation of anti-social behavior such as violence, drug abuse, criminal behavior, neglect and abuse of children, and to other problems including obesity, depression, and suicidal behavior. It is well known that if social inequality is present, bad outcomes (with regard to disease progression and consequences) can be expected both in individuals at the top and the bottom of the social hierarchy (22, 23).

Drinking alcohol in excess in any case represents a double risk (24).

Good intentions? Is it possible in the modern society where everything is subordinated to the welfare of the small number of people completely reversing the concept of disease and health, and to give everyone a chance to survive?

How can we do that? So far, the research (and interventions) focused on the effects on the population level, such as the increase in taxes, advertising bans, and the implementation of laws that prevent the use of alcohol in traffic. However, it seems that the problem may be viewed at the individual level.

In any case, the models of the treatment should be designed according to the needs of the individual. These models should incorporate not only the reduction of alcohol intake but also the path to abstinence. The plan should take into account the different (individual) needs for treatment, with regard to the degree of alcohol dependence and health status, and also include the needs of the family, community, and broader society.

MJ has developed main stream of ideas, has done literature search, and wrote the key theses. MA has done research and development of some of the basic theses.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.