Productivity losses from illness and premature death, which accounted for $11.78 billion, paint a grim picture of the impact of substance abuse on the workforce, the CCSA said. In addition, direct costs to the health care system exceeded $4 billion. According to the CCSA, costs associated with the use of alcohol and illicit drugs are largely avoidable; costs linked to smoking are avoidable to a lesser degree because of the persistent nature of tobacco-related disorders.