Skip to main content
SpringerLink
Log in

Cost-effectiveness of substance disorder interventions for people with severe mental illness

  • Regular Articles
  • Published:
The journal of mental health administration Aims and scope Submit manuscript

Abstract

This study examines the cost effectiveness of three intervention strategies for people with severe mental illness who are dually diagnosed clients in terms of service use and costs. The interventions represent three primary approaches to treating these disorders: 12-step recovery, case management, and behavioral skills training. Interim findings from the study indicate that all three approaches are reducing acute and subacute service use and increasing involvement with outpatient and case management treatments. However, both the case management and behavioral skills approaches reduce costs more than the 12-step recovery approach, although not to a statistically significant degree in the data collected thus far. Overall, the societal costs for these clients are reduced by 43% without increasing the burden on client families or on the criminal justice system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Goodwin D, Regier D, Farmer ME, et al.: Comorbidity of mental disorders with alcohol and other drug abuse: Results from the SCA study.Journal of the American Medical Association 1990; 246:2511–2518.

    Google Scholar 

  2. Schwartz SR, Goldfinger SM: The new chronic patient: clinical characteristics of an emerging subgroup.Hospital and Community Psychiatry 1981; 32(7):470–474.

    PubMed  CAS  Google Scholar 

  3. Pepper B, Kirschner MC, Ryglewicz H: The young adult chronic patient: An overview of a population.Hospital and Community Psychiatry 1982; 33(3):197–203.

    Google Scholar 

  4. Bachrach LL: Young adult chronic patients: An analytical review of the literature.Hospital and Community Psychiatry 1982; 33(3):189–197.

    PubMed  CAS  Google Scholar 

  5. Goldfinger SM, Hopkin JT, Furben RW: Treatment resisters or system resisters? Toward a better service system for acute care recidivists. In: Pepper B, Ryglewicz H (Eds.):New Directions for Mental Health Services: Advances in Treating the Young Adult Chronic Patient. San Francisco: Jossey-Bass, 1984, p. 17–27.

    Google Scholar 

  6. Bergman HC, Harris M: Substance abuse among young adult chronic patients.Psychosocial Rehabilitation Journal 1985; 9(1):49–54.

    Google Scholar 

  7. Safer DJ: Substance abuse by young adult chronic patients.Hospital & Community Psychiatry 1987; 38(5):511–514.

    CAS  Google Scholar 

  8. Sheets JL, Prevost JA, Reihman J: Young adult chronic patients: Three hypothesized subgroups.Hospital and Community Psychiatry 1982; 33(3):197–203.

    PubMed  CAS  Google Scholar 

  9. Annis HM: Is inpatient rehabilitation of the alcoholic cost effective.Advances in Alcohol & Substance Abuse 1986; 5:175–190.

    Google Scholar 

  10. Baekeland F: Evaluation of treatment methods in chronic alcoholism. In: Kissin B, Begleiter H (Eds.):Treatment and Rehabilitation of the Chronic Alcoholic. New York: Plenum Press, 1977, pp. 385–440.

    Google Scholar 

  11. Longabaugh R, McCrady B, Fink E, et al.: Cost-effectiveness of alcoholism treatment in partial vs. inpatient settings at six-month outcomes.Journal of Studies on Alcohol 1983; 44:1049–1071.

    PubMed  CAS  Google Scholar 

  12. Harrison PA, Martin JA, Tuason VB, et al.: Conjoint treatment of dual disorders. In: Alterman A (Ed.):Substance Abuse and Psychopathology. New York: Plenum, 1985, pp. 367–390.

    Google Scholar 

  13. Nathan PE, Niaura RS: Prevention of alcohol problems. In: Cox M (Ed.):Treatment and Prevention of Alcohol Problems: A Resource Manual. New York: Academic Press, 1987, pp. 332–355.

    Google Scholar 

  14. Stein LI, Test MA (Eds.):The Training in Community Living Model: A Decade of Experience. New Directions for Mental Health Services, no. 26. San Francisco: Jossey-Bass, 1985.

    Google Scholar 

  15. Willenbring ML, Ridgely MS, Stinchfield R, et al.:Application of Case Management in Alcohol and Drug Dependence: Matching Techniques and Populations. NIAAA Report. Washington, DC: U.S. Government Printing Office, 1990.

    Google Scholar 

  16. Lightfoot L, Rosenbaum P, Ogurzsoff S, et al.:Final Report of the Kingston Treatment Program Development Research Project. Canada: Department of Health and Welfare, Health Promotion Directorate, 1982.

    Google Scholar 

  17. McLachlan JFC: Benefit from group therapy as a function of patient-therapist match on conceptual level.Psychotherapy Theory, Research, and Practice 1972; 9:317–323.

    Google Scholar 

  18. Emrick CD: Alcoholics Anonymous: Affiliation processes and effectiveness as treatment.Alcoholism: Clinical and Experimental Research 1987; 11(5):416–423.

    Article  CAS  Google Scholar 

  19. Wright A: California’s Social Model: A Brief History and Statement of Basic Concepts. Paper presented at the American Public Health Association annual meeting, Boston, MA, November 1988.

  20. Bebbington PE: The efficacy of Alcoholics Anonymous: the elusiveness of hard data.British Journal of Psychiatry 1976; 128:572–580.

    Article  PubMed  CAS  Google Scholar 

  21. Emrick CD, Lassen CL, Edwards MT: Nonprofessional peers as therapeutic agents. In: Durman AS, Razin AM (Eds.):Effective Psychotherapy: A Handbook of Research. Oxford: Pergamon, 1977, pp. 120–161.

    Google Scholar 

  22. Leach B: Does Alcoholics Anonymous really work? In: Bourne PG, Fox R (Eds.):Alcoholism: Progress in Research and Treatment. New York: Academic Press, 1973, pp. 245–284.

    Google Scholar 

  23. Drake RE, Wallach MA: Substance abuse among the chronic mentally ill.Hospital & Community Psychiatry 1989; 40:1031–1036.

    Google Scholar 

  24. Drake RE, Antosca LM, Noordsy DL, et al.: New Hampshire’s specialized services for the dually diagnosed. In: Minkoff K (Ed.):Dual Diagnosis of Major Mental Illness and Substance Disorders. San Francisco: Jossey-Bass, 1991, pp. 57–67.

    Google Scholar 

  25. Azrin NH, Sisson RW, Meyers R, et al. Alcoholism treatment by disulfiram and community reinforcement therapy.Journal of Behavior Therapy and Experimental Psychiatry 1982; 13(2):105–112.

    Article  PubMed  CAS  Google Scholar 

  26. Foy DW, Nunn LB, Rychtarik RG: Broad-spectrum behavioral treatment for chronic alcoholics: Effects of controlled drinking skills.Journal of Consulting and Clinical Psychology 1984; 52(2):218–230.

    Article  PubMed  CAS  Google Scholar 

  27. Miller PM, Eisler RM: Assertive behavior of alcoholics: A description analysis.Behavior Therapy 1977; 8:146–149.

    Article  Google Scholar 

  28. Foy DW, Miller PM, Eisler, RM, et al.: Social skills training to teach alcoholics to refuse to drink effectively.Journal of Studies of Alcohol 1976; 37:1340–1345.

    CAS  Google Scholar 

  29. Van Hasselt VB, Hersen M, Milliones J: Social skills training for alcoholics and drug addicts: A review.Addictive Behaviors 1978; 3:221–234.

    Article  PubMed  Google Scholar 

  30. Marlatt GA, Gordon JR (Eds.):Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behavior. New York: Guilford Press, 1985.

    Google Scholar 

  31. Abrams DB: Psycho-social assessment of alcohol and stress interactions: Bridging the gap between laboratory and treatment outcome research. In: Pohorecky LA, Brick J (Eds.):Stress and Alcohol Use. New York: Elsevier Biomedical 1983, pp. 61–86.

    Google Scholar 

  32. Monti PM, Abrams DB, Kadden RM, et al.:Treating Alcohol Dependence: A Coping Skills Training Guide. New York: Guilford Press, 1990.

    Google Scholar 

  33. Intagliata JE: Increasing the interpersonal problem-solving skills of an alcoholic population.Journal of Consulting and Clinical Psychology 1978, 46:489–498.

    Article  PubMed  CAS  Google Scholar 

  34. Intagliata JC: Increasing the responsiveness of alcoholics to group therapy: An interpersonal problem-solving approach.Group 1979; 3:106–120.

    Article  Google Scholar 

  35. Sanchez-Craig M: Cognitive and behavioral coping strategies in reappraisal of stressful social situations.Journal of Counseling Psychology 1976, 23:7–12.

    Article  Google Scholar 

  36. Liberman RP, Engel J: Rehabilitation of the seriously mentally ill.Directions in Psychiatry 1989; 9(4):2–8.

    Google Scholar 

  37. Wei LJ, Lachin JM: Properties of the Um randomization method in clinical trials.Controlled Clinical Trials 1988; 9:345–364.

    Article  PubMed  CAS  Google Scholar 

  38. Schooler N, Weissman MM, Hogarty G: Social Adjustment Scale for schizophrenics. In: Hargreaves WA, Attkisson CC, Sorenson JE (Eds.):Resource Material for Community Mental Health Program Evaluators. USHEW Publication No. (ADM) 79328. Washington, DC: U.S. Government Printing Office, 1979, pp. 209–303.

    Google Scholar 

  39. Green RS, Gracely EJ: Selecting a rating scale for evaluating services to the chronically mentally ill.Community Mental Health Journal 1987; 23(2):91–102.

    Article  PubMed  CAS  Google Scholar 

  40. Stein LI, Test MA: Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation.Archives of General Psychiatry 1980; 37:392–397.

    PubMed  CAS  Google Scholar 

  41. Goldman HH, Morrissey JP, Ridgely MS: Form and function of mental health authorities at Robert Wood Johnson (RWJ) Foundation program sites: Preliminary observations.Hospital & Community Psychiatry 1990; 41:1222–1230.

    CAS  Google Scholar 

  42. McDonel E, Bond G, Segete DM, et al.: Implementing Innovative Case Management Programs for Persons with Severe and Persistent Mental Illness in Rural Settings: Findings and Questions Raised by a Two-Year Controlled Study. Presented at the National Association for Rural Mental Health Annual Conference, Lincoln, NE, June, 1993.

Download references

Author information

Authors and Affiliations

  1. Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Clinical Education Building, 3555 Harden Street Extension, 29203, Columbia, South Carolina

    Jeanette M. Jerrell Ph.D. (Professor of Neuropsychiatry and Behavioral Science)

  2. University of California, Berkeley

    Teh-wei Hu Ph.D. (professor of health economics)

  3. University of Maryland, Maryland, USA

    M. Susan Ridgely M.S.W. (associate director of the Mental Health Policy Studies Program)

Authors
  1. Jeanette M. Jerrell Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Teh-wei Hu Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Susan Ridgely M.S.W.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This study is funded by NIMH grant R01-MH46331, Jeanette M. Jerrell, Principal Investigator.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jerrell, J.M., Hu, Tw. & Ridgely, M.S. Cost-effectiveness of substance disorder interventions for people with severe mental illness. The Journal of Mental Health Administration 21, 283–297 (1994). https://doi.org/10.1007/BF02521335

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02521335

Keywords

Search

Navigation