The hidden toll of substance use disorder: annual cost of lost productivity to US economy nearly $93 billion
Peer-Reviewed Publication
Updates every hour. Last Updated: 9-Dec-2025 02:11 ET (9-Dec-2025 07:11 GMT/UTC)
A new study shows that in 2023, substance use disorders led to nearly $93 billion in lost productivity in the United States from missed work, reduced job performance, inability to work, and lost household productivity. The novel analysis appearing in the American Journal of Preventive Medicine, published by Elsevier, highlights the need for prevention and treatment strategies to reduce harm and costs.
Abstract
Purpose – With the increasing prevalence of common institutional ownership, a burgeoning literature has emerged to examine its economic consequences. However, the majority of existing studies focus on the product market and firm-level behavior and decision-making. Research on the impact of common institutional ownership on overall business strategy remains scarce. Therefore, this study aims to investigate the influence and mechanism of common institutional ownership on business strategy aggressiveness and explore the factors
that affect the relationship between the two.
Design/methodology/approach – We empirically examine the relationship between common institutional ownership and business strategy aggressiveness based on a sample of Chinese A-share listed companies from 2009 to 2023. In addition, we perform a series of endogeneity and robustness tests to validate our findings, including the Heckman two-stage tests, propensity score matching ordinary least squares, instrumental variables approach, placebo tests and remeasurement of key variables.
Findings – We find that common institutional ownership significantly reduces business strategy aggressiveness. Mechanism analyses suggest that the anti-competitive effects lead to a significant negative correlation between the two. Heterogeneity analyses indicate that the inhibitory effect of common institutional ownership on business strategy aggressiveness is more pronounced when common institutional investors are long-term oriented, the firms are state-owned and operate in non-technology-intensive industries, and the level of regional legalization is relatively low.
Originality/value – Our research provides novel evidence on how common institutional ownership shapes business strategy and presents implications for policymakers, corporations and investors.