Mr Achterstraat's report says that while most people consume alcohol responsibly, "there is a large group that consumes it at levels that present a risk of harm". It finds the NSW government doesn't have "a complete picture of the harm caused by alcohol in terms of its costs and effects on society". Accordingly, the NSW Audit Office asked Griffith University to estimate the annual cost of alcohol abuse to NSW government services. The university found the cost to be $1.029 billion in 2010 – or the equivalent of $416 per household. The largest cost was to NSW Police, followed by the Department of Family and Community Services (for out-of-home care and child protection services) and NSW Health (for hospitalisations). Griffith University estimated that, when social impact was taken into account – including lost productivity at work and at home – the "total societal cost" to NSW is $3.87 billion a year, or $1565 from each household.

This comprised of $915.2 million for the criminal justice system, $263.1 million for community services, $575.7 million for the health system, $1.856 billion in lost productivity and $256.6 million in road accidents. "It's fair to say that drunken behaviour is like a vacuum cleaner sucking resources out of other government services," Mr Achterstraat said. Every three years the government should estimate the costs of alcohol abuse incurred by government agencies, he recommended. "If you have better information, you can make better decisions," he said. "If it was better measured it could be better managed. The government needs to know how much it's spending, where it's spending it and how effective the spending is." Mr Achterstraat also said the government should examine options to recover the costs from people whose alcohol abuse requires government services and consider additional education strategies, including compulsory courses on responsible drinking.

In response, the director-general of the Department of Premier and Cabinet, Chris Eccles, noted the report stated that alcohol-related assaults have fallen by 23 per cent in NSW since 2008. He said the government had introduced a number of measures to address the impact of alcohol-related harm. These included the "three strikes" scheme for licensed premises, licensing crackdowns in Kings Cross and the trial of a mandatory sobering up centre in the Sydney CBD. Mr Eccles said fines were already levied on people detained in the sobering up centre under the trial. But he argued that broader cost recovery was inappropriate as it could "discourage individuals from accessing the services they need". He said that "at this time" the government does not support compulsory education courses "as a precondition for the provision of government services, such as healthcare".

The Last Drinks coalition of emergency service workers, which is campaigning for stricter licensing laws, said the findings should act as "a real wake-up call" for the government. "As if the human cost of alcohol-related harm wasn't enough, now the NSW government has an economic reason to take serious action on alcohol too," the Last Drinks spokesman and Australian Salaried Medical Officers Federation president Tony Sara said. The Last Drinks coalition is calling for earlier closing times, "lock-outs" and restrictions on high alcohol content drinks – a system that produced a 37 per cent drop in alcohol-related assaults at night in Newcastle. "It's hard to see that with all the evidence we now have, that the government could avoid introducing Newcastle-style measures elsewhere in the state any longer," Dr Sara said. Greens MP John Kaye criticised Mr Achterstraat's recommendation that the government should consider an "abuser pays" system.

"The alcohol industry should pay for the costs it imposes on government and society," he said. "It is unfair to suggest that those who fall prey to this industry's relentless quest for profits should foot the bill." Healthy Lifestyles Minister Kevin Humphries said while the 23 per cent reduction in assaults was encouraging, alcohol abuse remains a "challenge" for all governments. “Currently in NSW almost one in three people aged 16 and over drink at levels that put them at risk of harm – that's an extremely alarming statistic,” he said. Mr Humphries said the government has introduced public education campaigns including Know when to say when and What are you doing to yourself? "that raise awareness of the social and health impacts of binge drinking".