Current Psychiatry Reports

, Volume 1, Issue 2, pp 166–171

The cost-effectiveness of substance abuse treatment

  • Paul G. Barnett


Researchers have estimated the cost of treating substance abuse and its effects on medical care and social service expenses, but have rarely used the methods developed to evaluate medical care interventions. When outcomes are expressed as quality-adjusted life years, substance abuse treatment may be compared with other types of health care. This method has found smoking cessation and methadone maintenance to be highly cost-effective health care programs.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Reader JW, Sullivan KA: Private and public insurance. In Substance abuse: a comprehensive textbook. Edited by Lowinson JH, Ruiz P, Millman RB, Langrod JG. Baltimore: Williams & Wilkins; 1992:1067–1081.Google Scholar
  2. 2.
    Iglehart JK: Health policy report: managed care and mental health. N Engl J Med. 1996, 334:131–135.PubMedCrossRefGoogle Scholar
  3. 3.
    Gerstein DR, Harwood HJ: Treating drug problems: a study of the evolution, effectiveness, and financing of public and private drug treatment systems. Washington, DC: National Academy Press; 1990: 332:1–315.Google Scholar
  4. 4.
    US SAMHSA: Overview of the FY94 National Drug and Alcoholism Treatment Unit Survey (NDATUS): 1993 and 1980–1993. Rockville, MD: Substance Abuse and Mental Health Services Administration; 1995.Google Scholar
  5. 5.
    French MT, Dunlap LJ, Zarkin GA, et al.: A structured instrument for estimating the economic cost of drug abuse treatment. The Drug Abuse Treatment Cost Analysis Program (DATCAP). J Subst Abuse Treat 1997, 14:445–455.PubMedCrossRefGoogle Scholar
  6. 6.
    Holder H, Longabaugh R, Miller WR, Rubonis AV: The cost effectiveness of treatment for alcoholism: a first approximation. J Stud Alcohol 1991, 52:517–540.PubMedGoogle Scholar
  7. 7.
    Anderson DW, Bowland BJ, Cartwright WS, Bassin G: Service-level costing of drug abuse treatment. J Subst Abuse Treat 1998, 15:201–211. This study is the first detailed analysis of the cost of each different element of substance abuse treatment services.PubMedCrossRefGoogle Scholar
  8. 8.
    Dickey B, Azeni H: Person with dual diagnoses of substance abuse and major mental illness: their excess costs of psychiatric care. Am J Public Health 1996, 86:973–977.PubMedGoogle Scholar
  9. 9.
    Bartels SJ, Teague GB, Drake RE, et al.: Substance abuse in schizophrenia: service utilization and costs. J Nerv Ment Dis 1993, 181:227–232.PubMedCrossRefGoogle Scholar
  10. 10.
    Kivlahan DR, Heiman JR, Wright RC, et al.: Treatment cost and rehospitalization rate in schizophrenic outpatients with a history of substance abuse. Hosp Community Psychiatry 1991, 42:609–614.PubMedGoogle Scholar
  11. 11.
    Ingster LM, Cartwright WS: Drug disorders and cardiovascular disease: the impact on annual hospital length of stay for the Medicare population Am J Drug Alcohol Abuse 1995, 21:93–110.PubMedGoogle Scholar
  12. 12.
    Seage Gd, Hertz T, Stone VE, Epstein AM: The effects of intravenous drug use and gender on the cost of hospitalization for patients with AIDS. J Acquir Immune Defic Syndr 1993, 6:831–839.PubMedGoogle Scholar
  13. 13.
    Swan JH, Benjamin AE: IV drug use, dementia, and nursing home care for PWAs (persons with AIDS). J Health Soc Policy 1993, 4:79–91.PubMedCrossRefGoogle Scholar
  14. 14.
    Stein MD: Injected-drug use: complications and costs in the care of hospitalized HIV-infected patients. J Acquir Immune Defic Syndr 1994, 7:469–473.PubMedGoogle Scholar
  15. 15.
    Holder HD, Blose JO: Alcoholism treatment and total health care utilization and costs. A four-year longitudinal analysis of federal employees. JAMA 1986, 256:1456–1460.PubMedCrossRefGoogle Scholar
  16. 16.
    Yu J, Chen PJ, Harshman EJ, McCarthy EG: An analysis of substance abuse patterns, medical expenses and effectiveness of treatment in the workplace. Empl Benefits J 1991, 16:26–30.PubMedGoogle Scholar
  17. 17.
    Reiff S, Griffiths B, Forsythe AB, Sherman RM: Utilization of medical services by alcoholics participating in a health maintenance organization outpatient treatment program: three-year follow-up. Alcohol Clin Exp Res 1981, 5:559–562.PubMedGoogle Scholar
  18. 18.
    Jerrell J, Hu T-W: Estimating the cost impact of three dual diagnosis treatment programs. Evaluation Review 1996, 20:160–180.PubMedCrossRefGoogle Scholar
  19. 19.
    Rosenheck R, Gallup P, Frisman LK: Health care utilization and costs after entry into an outreach program for homeless mentally ill veterans. Hosp Community Psychiatry 1993, 44:1166–1171.PubMedGoogle Scholar
  20. 20.
    Rice DP, Kelman S, Miller LS: Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988. Public Health Reports 1991, 106:280–292.PubMedGoogle Scholar
  21. 21.
    Harwood H, Fountain D, Livermore G, Lewin Group: The Economic Costs of Alcohol and Drug Abuse in the United States, 1992. NIH publication 1998, 98–4327.Google Scholar
  22. 22.
    Harwood JJ, Hubbard RL, Collins JJ, Rachal JV: A cost benefit analyses of drug abuse treatment. Res Law Policy Stud 1995, 3:191–214.Google Scholar
  23. 23.
    Gerstein DR, Johnson RA, Harwood H, et al.: Evaluating recovery services: The California Drug and Alcohol Treatment Assessment (CALDATA). Sacramento: California Department of Alcohol and Drug Programs; 1994.Google Scholar
  24. 24.
    Berger H, Smith MJ: Economics of methadone maintenance [letter]. N Engl J Med 1974, 290:751.PubMedGoogle Scholar
  25. 25.
    Maidlow ST, Berman H: The economics of heroin treatment. Am J Public Health 1972, 62:1397–1406.PubMedGoogle Scholar
  26. 26.
    Scanlon JC: Proceedings: Cost savings/benefit analysis of drug abuse treatment. Am J Drug Alcohol Abuse 1976, 3:95–101.PubMedGoogle Scholar
  27. 27.
    French MT, Mauskopf JA, Teague JL, Roland EJ: Estimating the dollar value of health outcomes from drug-abuse interventions. Med Care 1996, 34:890–910.PubMedCrossRefGoogle Scholar
  28. 28.
    Alterman AI, O’Brien CP, McLellan AT, et al.: Effectiveness and costs of inpatient versus day hospital cocaine rehabilitation. J Nerv Ment Dis 1994, 182:157–163.PubMedCrossRefGoogle Scholar
  29. 29.
    Hayashida M, Alterman A, McLellan A, et al.: Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome. N Engl J Med 1989, 320:358–365.PubMedCrossRefGoogle Scholar
  30. 30.
    Fink E, Longabaugh R, McCrady B, et al.: Effectiveness of alcoholism treatment in partial versus inpatient settings: twenty-four month outcomes. Addict Behav 1985, 10:235–248.PubMedCrossRefGoogle Scholar
  31. 31.
    Mechanic D, Schlesinger M, McAlpine DD: Management of mental health and substance abuse services: state of the art and early results. Milbank Q 1995, 73:19–55.PubMedCrossRefGoogle Scholar
  32. 32.
    Walsh DC, Hingson RW, Merrigan DM, et al.: A randomized trial of treatment options for alcohol-abusing workers. N Engl J Med 1991, 325:775–782.PubMedCrossRefGoogle Scholar
  33. 33.
    McLellan A, Grissom G, Brill P, et al.: Private substance abuse treatments: are some programs more effective than others? J Substance Abuse Treat 1993, 10:243–254.CrossRefGoogle Scholar
  34. 34.
    McLellan AT, Arndt IO, Metzger DS, et al.: The effects of psychosocial services in substance abuse treatment. JAMA 1993, 269:1953–1959.PubMedCrossRefGoogle Scholar
  35. 35.
    Callahan JJ, Shepard DS, Beinecke RH, et al.: Mental health/ substance abuse treatment in managed care: the Massachusetts Medicaid experience. Health Aff (Millwood) 1995, 14:173–184.CrossRefGoogle Scholar
  36. 36.
    Rufener BL, Rachal JV, Cruze AM: Management effectiveness measures for NIDA drug abuse treatment programs, vol 1 and 2: Cost benefit analysis. Rockville: National Institute on Drug Abuse: 1977.Google Scholar
  37. 37.
    Gold MR, Siegel JE, Russell LB, Weinstein MC: Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.Google Scholar
  38. 38.
    Wasley MA, McNagny SE, Phillips VL, Ahluwalia JS: The costeffectiveness of the nicotine transdermal patch for smoking cessation [see comments]. Prev Med 1997, 26:264–270.PubMedCrossRefGoogle Scholar
  39. 39.
    Cromwell J, Bartosch WJ, Fiore MC, et al.: Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research. JAMA 1997, 278:1759–1766.PubMedCrossRefGoogle Scholar
  40. 40.
    Warner KE: Cost effectiveness of smoking-cessation therapies. Interpretation of the evidence-and implications for coverage. Pharmacoeconomics 1997, 11:538–549.PubMedGoogle Scholar
  41. 41.
    Barnett PG: The cost-effectiveness of methadone maintenance as a health care intervention. Addiction 1999, 94:479–488. The cost-effectiveness of methadone maintenance was modeled, and it was determined that access to treatment represents a highly costeffective medical therapy.PubMedCrossRefGoogle Scholar
  42. 42.
    Evers SM, Van Wijk AS, Ament AJ: Economic evaluation of mental health care interventions. A review. Health Econ 1997, 6:161–177.PubMedCrossRefGoogle Scholar
  43. 43.
    Kamlet MS, Paul N, Greenhouse J, et al.: Cost utility analysis of maintenance treatment for recurrent depression. Control Clin Trials 1995, 16:17–40.PubMedCrossRefGoogle Scholar
  44. 44.
    Torrance GW, Feeny D: Utilities and quality-adjusted life years. Int J Technol Assess Health Care 1989, 5:559–575.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2000

Authors and Affiliations

  • Paul G. Barnett
    • 1
  1. 1.Health Economics Resource Center and Center for Health Care EvaluationVA Palo Alto Health Care SystemMenlo ParkUSA

Personalised recommendations